One-stop colonoscopy-based management of rectal bleeding from internal hemorrhoids: a real-world comparative study

Rectal bleeding commonly prompts colonoscopy to exclude colorectal cancer before symptoms are attributed to hemorrhoids. We evaluated a one-stop, colonoscopy-based strategy for integrating diagnosis and treatment of bleeding internal hemorrhoids. We retrospectively analyzed patients with grade II–III internal hemorrhoids presenting with rectal bleeding who underwent colonoscopy between May 2023 and November 2024. After complete diagnostic colonoscopy and exclusion of colorectal cancer and other definite sources of bleeding, endoscopic hemorrhoidal treatment was performed during the same procedural session. Clinical outcomes, safety, recurrence, patient-reported satisfaction, and treatment cost of this one-stop strategy were evaluated by comparing endoscopic polidocanol foam sclerotherapy (EPFS) and rubber band ligation (RBL). Subgroup analyses were performed according to polidocanol concentration. A total of 294 patients were included (EPFS, n = 226; RBL, n = 68). The one-stop approach was feasible in all cases with no major adverse events. Bleeding control and recurrence rates were comparable between EPFS and RBL during ≥ 12-month follow-up. EPFS achieved clinical outcomes comparable to those of RBL while being associated with lower index treatment cost. Within EPFS, 3% polidocanol showed lower recurrence than 1% without differences in safety or satisfaction. A one-stop colonoscopy-based strategy is safe and effective. EPFS represents a practical treatment option within this one-stop management pathway while maintaining clinical outcomes comparable with those of RBL.