S1366 Long-Term Outcomes of Hemorrhoidal Artery Embolization With and Without Prior Rubber Band Ligation: A Multicenter Retrospective Study

Introduction: Hemorrhoidal disease is a prevalent gastrointestinal condition with significant healthcare burden, affecting over 4.4% of the global population. Rubber band ligation (RBL) is widely recognized as the first-line, office-based therapy for hemorrhoidal disease. Hemorrhoidal artery embolization (HAE) has emerged as an effective alternative, offering comparable symptom relief and post-procedural pain. However, the influence of prior RBL on HAE outcomes has not been thoroughly investigated. This study evaluates the long-term efficacy of HAE in patients with and without prior RBL. Methods: Multicenter retrospective review of 405 patients with symptomatic internal hemorrhoids that were treated with HAE between August 2021 and August 2024. Patients were stratified based on prior RBL. HAE was performed using absorbable microspheres followed by microcoil embolization of the superior and, when necessary, middle rectal arteries. Patients were evaluated at 1-, 6-, and 12-months post-procedure using hemorrhoid-related pain (HRP), hemorrhoid symptom score (HSS), quality of life (QoL), French bleeding score (FBS), and hemorrhoid grade (HG). Repeated measures ANOVA assessed changes over time and differences by RBL status. Results: HAE resulted in significant improvement in all measured outcomes. HRP decreased by 66.1%, 72.3%, and 71.0% at 1, 6, and 12 months, respectively (all P < 0.0001). HSS showed a 26.8–29.4% reduction (P < 0.0001), while QoL improved by over 50% across all time points. FBS decreased by approximately 45–48%, and HG showed a statistically significant reduction at early follow-up. ANOVA showed that prior RBL did not negatively impact HAE efficacy with no significant difference in reported outcomes between the 2 groups. Adverse events were limited and were all successfully managed conservatively. Conclusion: HAE is a safe and effective outpatient treatment for internal hemorrhoids, demonstrating durable symptom relief regardless of prior RBL. These findings support the consideration of HAE not only as a salvage therapy but also as a primary intervention in appropriately selected patients, expanding its role in hemorrhoidal disease management.