Efficacy and safety of endoscopic retrograde ligation of bleeding internal hemorrhoids

Background and Aims: Endoscopic hemorrhoidal ligation may provide an alternative to surgical treatment of internal hemorrhoids. This study assessed the safety and efficacy of endoscopic retrograde ligation for bleeding internal hemorrhoids. Methods: Endoscopic retrograde ligation was performed in 20 adult patients who had chronic rectal bleeding attributed to internal hemorrhoids. Elastic bland ligation was accomplished using a ligating device attached to the end of a video endoscope. Repeat endoscopy was done three weeks after the initial procedure. Results: 70 band ligations were performed during 23 separate sessions. Post-therapy endoscopy showed reduction of hemorrhoidal size by at least 1 grade in 19 of 20 (95%) patients. Bleeding resolved in 19 of 20 (95%) of patients in 5.4 months (mean) of follow up. Eighteen of twenty (90%) required only one banding session. No major complications (perforation, secondary bleeding, deep ulceration) occurred in this small group. Conclusions: Preliminary data indicates that endoscopic retrograde ligation is a safe and effective technique for treating internal hemorrhoids. It holds promise as an important technique for successfully treating and possibly eradicating symptomatic internal hemorrhoids.