Endoscopic Hemorrhoidal Ligation (EHL )

 What is Endoscopic Hemorrhoidal Ligation?

Endoscopic Hemorrhoidal Ligation (EHL) or Rubber band ligation is one of the most widely used treatment for internal hemorrhoids. An applicator is used to place one or two small rubber bands around the base of the hemorrhoid, cutting off its blood supply. After 3-10 days, the rubber bands and the hemorrhoid fall off, leaving a scab which disappears within a week or two.  Endoscopic Hemorrhoidal Ligation (EHL) is one of the best treatments for internal hemorrhoids.  This procedure is performed in the office on an outpatient basis. An applicator is used to place small rubber bands around the base of the hemorrhoid, cutting off its blood supply. After 3 to 10 days the bands and the hemorrhoids fall off, leaving a sore that heals in a week or two. Because internal hemorrhoids are located in a part of the anus that does not sense pain, anesthetic is usually unnecessary and the procedure is painless in most cases. Although there can be minor discomfort and bleeding for a few days after the bands are applied, complications are rare and most people are soon able to return to work and other activities. If more than one hemorrhoid exists or if banding is not entirely effective the first the procedure may need to be repeated a few weeks later. After five years, only 15–20% of patients experience a recurrence of internal hemorrhoids, but in most cases all that is needed is another banding.

 

What are the possible complications?

Tenesmus: which is a feeling of incomplete defecation is the most common symptom after the EHL procedure. It is experienced as an inability or difficulty to empty the bowel at defecation. It may last 3 to 10 days after the procedure but resolves once the bands fall.

Pain: Mild pain or a feeling of pressure is normal and should go away within one to two hours.

Bleeding: Some bleeding normally occur at the first bowel movement after the procedure. However, severe bleeding which requires hospitalization and blood transfusion is very rare and occurs at a rate of less than 1%.

Infection and Pelvic Sepsis: Although rare (<1%), complications involving post-treatment infection and sepsis are very serious and can be life-threatening. Call the doctor immediately if any of these symptoms occur:

• Blood clot: In about 5% of patients, a very painful blood clot develops in a condition called thrombosed hemorrhoids. Surgery may be necessary to excise this type of hemorrhoids.
• Anal fissure: Fissure develops in about 1% of the patients as a result of sloughing of the hemorrhoid. However, most cases of fissure can be treated medically.

 

How common is Banding?

An estimated 50 million banding procedures are performed worldwide each year.

 

 

*   EHL is not for treatment of external hemorrhoids or non-bleeding internal hemorrhoids).

** Anoscopy: Examination of the anal canal and lower rectum with a finger-sized instrument.