Hemorrhoidal Artery Embolization Demonstrates Long-term Efficacy in Symptomatic Hemorrhoid Treatment: A Stratified Multicenter Study of 405 Patients with and without Prior Rubber Band Ligation

Purpose: Hemorrhoidal Artery Embolization (HAE) has emerged as an effective treatment for symptomatic bleeding internal hemorrhoids. However, the influence of prior rubber band ligation (RBL) on HAE outcomes has not been previously examined. This study aims to evaluate and compare the long-term outcomes of HAE in patients with and without a history of RBL, demonstrating its efficacy as a durable solution regardless of prior interventions.

Materials and Methods: In this multicenter study, 405 patients with refractory symptomatic internal hemorrhoids were treated with HAE from August 2021 to August 2024, including 125 patients who had undergone prior RBL. Target arteries with abnormal vascular blush in the hemorrhoidal cushion were embolized via superior and/or middle rectal artery using spherical particles (500 or 600 μm) and/or microcoils (2-6 mm). All patients were discharged the same day and followed up at baseline, 1, 3, 6, and 12 months to assess standardized outcomes: hemorrhoid-related pain (HRP; 0-10), hemorrhoid symptom score (HSS; 5-20), quality of life (QoL; 0-4), French bleeding score (FBS; 0-9), and hemorrhoidal grade (HG; 0-4). Outcomes were stratified by prior RBL status for comparison.

Results: Overall, HAE demonstrated robust efficacy, with significant improvement across all primary outcomes at 12 months: HSS (from 10.8 to 7.7; p < 0.01), HRP (from 4.1 to 1.1; p < 0.01), QoL (from 2.0 to 1.0; p < 0.01), and FBS (from 4.3 to 2.5; p < 0.01). A significant reduction in hemorrhoidal grade was noted at 6 months (from 2.8 to 2.6; p < 0.05), although this was not sustained at 12 months (2.8 to 2.7; p = 0.26). Stratified analysis comparing patients with and without prior RBL (n=279 vs. 126) revealed no significant differences in HSS, QoL, FBS, and HG outcomes. While HRP significantly improved in both groups at 12 months, HRP was significantly more improved at 12 months in patients with prior RBL (p = 0.01), while no differences were observed at 1 and 6 months.

Conclusion: HAE is a highly effective intervention for symptomatic internal hemorrhoids, demonstrating consistent outcomes regardless of prior RBL treatment. These findings underscore the potential of HAE as a durable therapeutic option for patients naïve to, or refractory, to RBL.