Benefits of Performing Rubber Band Ligation of Internal Hemorrhoids via Endoscopy

Rubber band ligation of internal hemorrhoids remains one of the most effective modes of treating internal hemorrhoids in the ambulatory care setting.  Unfortunately most primary care physicians and gastroenterologists have not been trained in this modality.  A referral to a surgeon often creates anxiety in patients about the potential for surgical intervention.  Furthermore 98% with symptomatic internal hemorrhoids could be treated by physicians in the medical clinic and do not require surgery.  Internal hemorrhoids can be readily diagnosed and graded in the office setting with the use of simple anascope or proctoscope.  However optimal visualization of the anorectal anatomy in the midst of hemorrhoidal therapy can be challenging as the physician’s field of vision is often limited as he tries to look through the pinhole of an anascope.   As such I’ve found the endoscopic approach to endoscopic band ligation provides multiple benefits.

1) Endoscopic evaluation of the lower GI tract (flexible sigmoidoscopy or colonoscopy),  in conjunction with band ligation, provides  additional diagnostic benefit to the patient and can readily exclude colitis, neoplasm, rectal ulceration, fistula and other mucosal diseases that may mimic hemorroidal bleeding.

2) Endoscopy provides great visual field of the anal canal and rectal anatomy compared to anascopy.  The images from the videoendoscope can be readily projected to a large screen monitor for real-time examination and photodocumentation.  In the retroflexed view of endoscopy, the layout of the hemorrhoidal complex and the dentate line is visualized in great detail.  Furthermore the endoscope provides more precise delivery of the rubber band at the time of ligation.

3) In the setting the of colonoscopy, the patient is prepped, sedated and comfortable throughout the procedure and typically has no recollection of the rubber band ligation.

4) Endoscopic band ligators provide for multiple hemorrhoidal banding capability.   This is in contrast to office based rubber band ligation, which is typically  performed on one hemorrhoid per session.   Hence patients typically need 1-2 sessions of endoscopic band ligation as opposed to 3-4 sessions of traditional rubber band ligation.

5) Charges for the hemorroidectomy (via endoscopic band ligation) when performed in conjunction with colonoscopy, is actually less expensive compared to office based rubber band ligation, due to the fact that the banding procedure is discounted by the insurance company in the setting of colonoscopy.