Efficacy and safety of endoscopic sclerotherapy vs traditional surgery in the treatment of internal hemorrhoids: A meta-analysis

BACKGROUND Internal hemorrhoids are among the most common colorectal diseases worldwide. Although traditional surgeries (TS) are widely used, postoperative complications or discomfort may occur to varying degrees. In recent years, endoscopic sclerotherapy (ES) has gradually emerged as a minimally invasive alternative; however, its overall clinical value compared with that of TS has not yet been clearly confirmed. AIM To evaluate the impact of ES in comparison to TS on internal hemorrhoid outcomes. METHODS A comprehensive search was conducted across several databases, including the PubMed, EMBASE, Cochrane Library, Clinical trials.gov, China National Knowledge Infrastructure, Wanfang, and VIP databases. This search aimed to identify randomized controlled trials (RCTs) that compared ES with TS in patients who underwent internal hemorrhoid surgery. The primary outcome assessed was clinical efficacy, whereas the secondary outcomes included complications and other essential clinical metrics. A total of 17 RCTs involving 1689 patients were included in the meta-analysis. RESULTS The results of the pooled analysis indicated that, compared with TS, ES exhibited superior clinical efficacy. Furthermore, ES had a minimal effect on work resumption and demonstrated superior efficacy in controlling bleeding and reducing hemorrhoid prolapse in comparison to TS. Compared with TS, ES significantly reduced the incidence of postoperative complications, including bleeding, anal bulge, anal edema, urinary retention, and infection. Additionally, ES was associated with lower treatment costs, shorter hospitalization durations, shorter healing times, shorter operation times, and less blood loss. In patients with internal hemorrhoids, compared with TS, ES resulted in faster recovery, a lower risk of complications and superior efficacy. CONCLUSION Therefore, ES is a safe and effective surgical method for the treatment of internal hemorrhoids.