Efficacy of injection sclerotherapy versus rubber band ligation for grades I–III internal hemorrhoids: A systematic review and meta-analysis

To compare injection sclerotherapy (IS) versus rubber band ligation (RBL) for grades I–III internal hemorrhoids regarding treatment effectiveness, patient satisfaction, recurrence, and postoperative pain. PubMed, Embase, Scopus, Web of Science, and major Chinese databases were searched up to November 2025 for comparative studies. Pooled risk ratios with 95% confidence intervals were calculated using random-effects models. Eleven studies (2235 patients) were included. IS and RBL showed no significant differences in treatment effectiveness (RR = 1.01, 95%CI 0.96–1.06, P = 0.681) or patient satisfaction (RR = 0.88, 95%CI 0.74–1.06, P = 0.171). However, IS was associated with significantly higher recurrence (RR = 1.51, 95%CI 1.07–2.12, P = 0.012) but lower moderate-to-severe postoperative pain (RR = 0.20, 95%CI 0.06–0.70, P = 0.002). Sensitivity analyses confirmed robust findings for effectiveness and pain; recurrence results lacked robustness and require cautious interpretation due to limited studies and inconsistent follow-up. IS and RBL offer comparable effectiveness. IS provides superior pain control, while RBL may confer lower recurrence risk, though this finding remains uncertain. Treatment selection should prioritize predominant symptoms (bleeding vs. prolapse) and patient preferences over hemorrhoidal grade alone.