EP922 - The advantages of injection sclerotherapy compared with rubber band ligation in patients with severe anemia due to hemorrhoids

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Purpose/Background: Sometimes copious hemorrhoidal bleeding can cause iron deficiency anemia with associated symptoms of weakness, headache, irritability, and varying degrees of fatigue and exercise intolerance. After other causes are excluded via colonoscopy, hemorrhoids are considered. Hemorrhoids with bleeding as the main symptom can lead to anemia if not treated promptly. In such cases, transfusion and surgery should be performed as soon as possible. We were attempting to determine how our hospital manages patients with severe anemia due to hemorrhoids, and summarized our experiences.

Methods/Interventions: Between February 2018 and August 2023, 74 patients with severe anemia due to hemorrhoids were treated at Longhua Hospital Shanghai University of Traditional Chinese Medicine. Inclusion criteria comprised individuals over 18 years old experiencing recurrent hemorrhoidal bleeding and diagnosed with severe anemia. Hemorrhoidal disease was classified according to the Goligher classification, while the severity of anemia was categorized based on World Health Organization standards (severe anemia = hemoglobin < 90 g/L). Exclusion criteria encompassed any conditions other than hemorrhoids that could cause bleeding. Hemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale (SHS) were used to measure patients’ HD symptoms. We used hemorrhoidal bleeding score (HBS) to assess the severity of hemorrhoidal bleeding. Therapeutic success was defined as remission of bleeding symptoms, with HBS lower than 3 points after treatment. Recurrence was defined as HBS scores of 3 points or higher. The data in this study were statistically analyzed using SPSS 25.0 software, with the mean ± standard deviation used for the measured data. A difference was considered statistically significant when P < 0.05.

Results/Outcomes: A total of 74 patients with follow-up were analyzed. 38 patients were treated with IS and 36 patients were treated with RBL. There were no differences in sex, age, blood transfusion number of people, BMI, preoperative HDSS, preoperative SHS, preoperative HBS, Goligher grade and on admission hemoglobin. 18 patients received blood transfusion in both groups. We found during 2018-2020, RBL was preferred by both patients or surgeons, but after 2020（covid-19, Is was the preferred. Both groups showed significant improvements in HBS, HDSS, and SHS scores after surgery (P=0.000). Operation time and hospitalization days were shorter in the IS group than RBL group (27.58±16.64 min vs 48.33±21.22 min, P=0.000; 6.34±2.96 days vs 9.61±2.94 days, P=0.000). At the 3 months follow-up point, hemoglobin levels in both groups returned to normal with no statistical difference. (P=0.346). At the 12 months follow-up point, no differences were found in re-operation rate (P=0.786), Hemorrhoidal Bleeding Scores（HBS,P=0.682), Hemorrhoidal Disease Symptom Scores (HDSS,P=0.751) or Short Health Scale scores (SHS,P=0.636) in the two groups. No complications were reported in the IS group.

Conclusion/Discussion: Both RBL and IS are effective for treating severe anemia due to hemorrhoids, but the IS group has shorter operation time and hospitalization days and fewer complications.