title: A randomized trial of rubber band ligation with or without injection sclerotherapy in the treatment of piles.
abstract: OBJECTIVE
  Rubber band ligation (RBL) is an effective treatment for piles but may be followed by pain and bleeding. It is postulated that the addition of injection sclerotherapy (IS) may reduce these complications. This trial aims to compare the use of RBL alone with RBL + IS in the treatment of piles.
  
  
  METHODS
  Sixty patients with piles were randomized to RBL alone (n=30) or RBL + IS (n=30). Each patient was given a pro forma on which to record the amount of pain (on a visual analogue scale) and bleeding (none, slight or heavy) for 10 days following treatment. Patients were subsequently asked to describe the overall symptomatic outcome in the 6-week follow-up clinic (worse, same, slightly better, much better). Long-term outcome was ascertained by a telephone survey.
  
  
  RESULTS
  Symptomatic improvement was similar in both groups (median score (range)=1.5 (0-2) vs 2 (0-2); P=NS), and there was no difference in pain (median score (range)=6 (0-77) vs 6 (0-50); P=NS). However, the amount of bleeding was significantly less in the RBL + IS group (median score (range)=3.5 (0-12) vs 0 (0-10); P < 0.001). The long-term outcome was similar in both groups.
  
  
  CONCLUSIONS
  The addition of IS to RBL does not affect procedure-related pain or symptomatic outcome, but significantly reduces the risk of post-bleeding.
authors.affiliation: Department of Surgery, Central Sheffield University Hospitals, Sheffield, UK.
authors.lastname: Ackroyd
authors.lastname: Dicks
authors.lastname: Shorthouse