Efficacy and safety of bipolar energy-based therapy for hemorrhoids: a systematic review.

Background: Hemorrhoids arise from dilated vessels in the submucosal layer of the anorectal canal. Hemorrhoids are responsible for 4 million office and emergency visits annually in the US. Hemorrhoidal energy therapy (HET) is a novel nonsurgical, bipolar energy-based instrument for treating hemorrhoids. It has multiple benefits, such as requiring only a single session for resolution of symptoms, and minimizing heat-related collateral damage. However, there are limited data regarding the effectiveness and adverse events of HET. We performed the first systematic review to evaluate the efficacy and safety of HET in the treatment of internal hemorrhoids. Methods: A comprehensive search was performed from major databases to identify studies that investigated HET to treat hemorrhoids. The primary outcomes were technical success and clinical success. The secondary outcomes were total adverse events and individual adverse events, such as postprocedural bleeding and incontinence. Results: Eight studies with 512 patients were included in the meta-analysis. The average age was 55.6 years, and the majority of patients were female. Most patients presented with grade I and grade II hemorrhoids. The HET demonstrated technical and clinical success rates of 100% and 86.1%, respectively. All adverse events were determined to be mild, according to the ASGE lexicon, except for 1 case of perianal hematoma that required hospitalization. Conclusion: Our study demonstrates that HET is an effective and safe treatment for grade I and II internal hemorrhoids.