title: A prospective randomised comparative study of endoscopic band ligation versus injection sclerotherapy of bleeding internal haemorrhoids in patients with liver cirrhosis.
abstract: OBJECTIVE
  Bleeding internal haemorrhoids are common and used to be treated surgically with too many complications. Endoscopic therapy is trying to take the lead. Sclerotherapy and rubber band ligation are the candidates to replace surgical therapy especially in patients with liver cirrhosis. The aim of this study was to compare endoscopic injection sclerotherapy (EIS) to endoscopic rubber band ligation (EBL) regarding effectiveness and complications in the treatment of bleeding internal haemorrhoids in Egyptian patients with liver cirrhosis.
  
  
  METHODS
  One hundred and twenty adult patients with liver cirrhosis and bleeding internal haemorrhoids were randomised into two equal groups; the first treated with EBL using Saeed multiband ligator, and the second with EIS using either ethanolamine oleate 5% or N-butyl cyanoacrylate. All groups were matched as regards age, sex, Child score and pre-procedure Doppler values. Patients were followed up clinically and with abdominal ultrasound/Doppler for 6 months. Endoscopic and endosonography/Doppler was done before and one month after the procedure. Pre and post-procedure data were recorded and analysed.
  
  
  RESULTS
  Both techniques were highly effective in the control of bleeding from internal haemorrhoids with a low rebleeding [10% in the EBL group and 13.33% in the EIS group] and recurrence [20% in the EBL group 20% in the EIS group] rates. Child score had a positive correlation with rebleeding and recurrence in EIS group only. Pain score and need for analgesia were significantly higher while patient satisfaction was significantly lower in EIS compared to EBL [p<0.05]. No significant difference between ethanolamine and cyanoacrylate subgroups was found [p>0.05].
  
  
  CONCLUSIONS
  Both EBL and EIS were effective in the treatment of bleeding internal haemorrhoids in patients with liver cirrhosis. EBL had significantly less pain and higher patient satisfaction than EIS. EBL was also safer in patients with advanced cirrhosis.
authors.affiliation: Tropical Medicine & Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Atif ElSayed
authors.initials: AE
authors.lastname: Awad
authors.forename: Hanan Hamed
authors.initials: HH
authors.lastname: Soliman
authors.forename: Sabry Abdel Latif Abou
authors.initials: SA
authors.lastname: Saif
authors.forename: Abdel Monem Nooman
authors.initials: AM
authors.lastname: Darwish
authors.forename: Samah
authors.initials: S
authors.lastname: Mosaad
authors.forename: Asem Ahmed
authors.initials: AA
authors.lastname: Elfert
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D004659:Enbucrilate / Q000627:therapeutic use; D019160:Endosonography; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006484:Hemorrhoids / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000627:therapeutic use; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D011351:Proctoscopy; D012008:Recurrence; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000009:adverse effects
chemical_list: D009829:Oleic Acids; D012597:Sclerosing Solutions; D004659:Enbucrilate; C033343:ethanolamine oleate