S1424 Evaluation of Rubber Band Ligation Versus Sclerotherapy for the Treatment of Internal Hemorrhoids: A Meta-Analysis

Introduction: Internal hemorrhoids are a common condition worldwide. Many modalities have emerged to treat higher-grade and those who have not responded to conservative management. In this paper, we aim to evaluate rubber band ligation compared to injection sclerotherapy as therapeutic options for internal hemorrhoids. Methods: On November 15, 2024, a data search was conducted using PubMed, Scopus, and the Cochrane Library. Our inclusion criteria were any paper comparing rubber band ligation to sclerotherapy for the treatment of internal hemorrhoidal disease. We studied short term outcomes such as the overall control of symptoms (pain and bleeding), prolapse reduction, and bleeding control, and post-procedural pain and bleeding. We used the odds ratio with a 95% confidence interval to estimate the effect size, employing a random-effects model. Results: Out of 349 articles screened, only 9 were eligible, with a total of 1629 patients. In our analysis, we found that overall control of symptoms was higher in the rubber band group compared to sclerotherapy, with an odds ratio of 2.83 (CI: 1.67 to 4.80, P < 0.001). Similarly, bleeding control was significantly higher in the rubber band group compared to sclerotherapy, with an odds ratio of 2.25 (CI: 1.38 to 3.67, P = 0.001). Additionally, prolapse reduction was significantly higher in the rubber band arm, with an odds ratio of 7.11 (CI: 4.66 to 10.85, P < 0.001). In terms of post-operative pain, it was higher in the rubber band group, with an odds ratio of 2.32 (CI: 1.30 to 4.14, P = 0.004). However, there was no significant difference between the 2 groups in terms of post-operative bleeding (OR = 1.32, 95% CI: 0.75 to 2.33, P = 0.34). Conclusion: Our paper demonstrated the superiority of rubber band ligation compared to injection sclerotherapy for the treatment of internal hemorrhoids. This was evidenced by higher rates of bleeding control, prolapse reduction, and overall symptom control.