Introduction: Rubber band ligation (RBL) and infrared coagulation (IRC) have been used as office-based procedures in hemorrhoidal disease (HD). Few studies have been published comparing the various types of instrumental therapy. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of RBL and IRC.
Methods: We conducted a systemic review and meta-analysis on the studies that compared RBL and IRC. We performed a comprehensive search in the databases of PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception through May, 2022. We considered randomized controlled trials. From each study, we collected the number of patients who were treated with RBL and the number of patients IRC. The primary outcome was overall control of symptoms. The secondary outcomes were disease recurrence, post-procedural pain, and post-procedural bleeding. The random-effects model was used to calculate the odds ratios (OR), mean differences (MD), and confidence intervals (CI). A p-value < 0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index.
Results: Six randomized controlled trials involving 359 patients treated with RBL and 381 patients treated with IRC were included in the meta-analysis. The overall control of symptoms was not statistically different between RBL and IRC (OR 1.39, 95% CI 0.94-2.08, p =0.09, I2 = 0%) (Figure 1A). However, disease recurrence was significantly less in RBL compared with IRC (OR 0.27, 95% CI 0.15-0.48, p =0.00, I2 = 0%) (Figure 1B). Post-procedural pain was significantly more in RBL compared with IRC (OR 2.8, 95% CI 1.2-6.4, p =0.01, I2 = 70%) (Figure 1C). No significant difference was observed in post-procedural bleeding between two groups (OR 0.5, 95% CI 0.16-1.7, p =0.29, I2 = 74.9%).
Discussion: Our meta-analysis demonstrated that RBL is associated with less disease recurrence. There was no statistical difference in overall control of the symptoms or post-procedural bleeding. However, it was associated with more post-procedural pain. Further randomized controlled trials are needed to confirm our findings.
