title: Endoscopic band ligation of internal haemorrhoids versus stapled haemorrhoidopexy in patients with portal hypertension.
abstract: OBJECTIVE
  Portal hypertension is common in Egypt as a sequela to the high prevalence of hepatitis C virus and bilharziasis. In portal hypertension internal haemorrhoids are frequently found. The aim of this work was to compare the outcome of endoscopic band ligation (EBL) of symptomatic internal haemorrhoids with that of stapled haemorrhoidopexy (SH) in Egyptian patients with portal hypertension.
  
  
  METHODS
  In this study, 26 portal hypertensive patients (with oesophageal and/or fundal varices) with a grade 2-4 internal haemorrhoids who had no coagulation disorders were randomised to treatment by EBL (13 patients) or SH (13 patients) after doing colonoscopy. Symptom scores of bleeding and prolapse were assessed before and after the intervention. Complications were recorded. Patients were followed up for 12months.
  
  
  RESULTS
  Goligher's grades of internal haemorrhoids improved significantly (p=0.018) 12weeks after SH (from 2.9±0.8 to 0.4±0.5; p=0.001) and after EBL (from 2.8±0.8 to 1.1±0.8; p=0.001). Symptom (bleeding and prolapse) scores significantly improved 4weeks after both EBL (from 1.6±0.8 to 0.6±0.8; p<0.001 and from 1.6±0.9 to 0.5±0.5; p=0.002, respectively) and SH (from 1.8±0.8 to 0.2±0.4; p=0.002 and from 1.5±0.9 to 0.2±0.4; p=0.001, respectively). The differences after 4weeks between EBL and SH were not significant (p=0.168 and p=0.225). Pain requiring analgesics occurred in five patients (38.5%) after EBL, compared with six (46.2%) after SH (p=0.691). Minimal bleeding occurred in two patients (15.4%) after EBL but not with SH; urinary retention was observed in one patient after EBL compared with two after SH; and anal fissures were observed in one patient after EBL. During 1-year follow-up, increased frequency of stool occurred in one patient after EBL. Recurrence of symptoms was observed in three patients after EBL and in one after SH.
  
  
  CONCLUSIONS
  For portal hypertensive patients with internal haemorrhoids and without coagulation disorders SH seems to be superior to EBL. However further studies are needed to evaluate EBL in different grades of cirrhosis.
authors.affiliation: Gastrointestinal Endoscopy Unit, Endemic and Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt. tareqzaher@zu.edu.eg
authors.forename: Tarik
authors.initials: T
authors.lastname: Zaher
authors.forename: Islam
authors.initials: I
authors.lastname: Ibrahim
authors.forename: Amany
authors.initials: A
authors.lastname: Ibrahim
mesh_terms: D000328:Adult; D003113:Colonoscopy; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008026:Ligation / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D017792:Surgical Stapling; D016896:Treatment Outcome