Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background: Injection sclerotherapy is widely used for grade I-III internal hemorrhoids, but evidence comparing multiple sclerosing agents head-to-head is limited. Methods: Pubmed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang Data, and grey literature sources were searched for randomized controlled trials (RCTs) reporting cure rate as the primary outcome. A Bayesian network meta-analysis was performed using Markov chain Monte Carlo simulations. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and treatments were ranked using surface under the cumulative ranking curve (SUCRA) values. Outcomes assessed included cure rate, recurrence rate, patient satisfaction, and operative complications. Results: Sixty-six RCTs were included. Polidocanol foam demonstrated significantly higher cure rates compared with polidocanol liquid (OR = 3.1, 95% CI: 2.3-4.2) and ranked first among all treatments for cure rate and patient satisfaction. It also showed the lowest risk of overall complications (OR = 0.53 vs. polidocanol liquid, 95% CI: 0.22-1.3), with significantly reduced risks of bleeding (OR = 0.4, 95% CI: 0.21-0.9) and rectal stricture (OR < 0.001, 95% CI: <0.001-0.73). XiaoZhiLing, phenol, and 50% dextrose were significantly inferior to polidocanol liquid in cure rate. Subgroup analyses in internal hemorrhoids, grade I/II, and grade I/II/III hemorrhoids consistently supported the superiority of polidocanol foam. Conclusion: Polidocanol foam showed best efficacy among all sclerosing agents for treating hemorrhoids, ranking first in cure rate and patient satisfaction with lowest complication risks, particularly for bleeding and rectal stricture. These findings support polidocanol foam as the preferred sclerosing agent in clinical practice. However, as most included trials had follow-up durations of less than 1 year, the long-term durability of these benefits and the risk of late recurrence remain to be established. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261379386, PROSPERO CRD420261379386.
Source: Frontiers in Medicine
Authors: Bin Chen, Zhenguo Zhang, Xinru Xiong, Chilei Shen
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7220835682