S219 Safety and Efficacy of Hemorrhoid Energy Therapy: Systematic Review and Meta-Analysis

Introduction: Hemorrhoids are the fourth leading outpatient gastrointestinal diagnosis, requiring healthcare expenses of approximately $770 million annually. Standard conservative measures are typically ineffective, while banding and hemorrhoidectomy have risks of recurrence and patient discomfort. Hemorrhoid Energy Therapy (HET) is emerging as a promising minimally invasive treatment for grades I and II internal hemorrhoids. We assessed treatment outcomes of HET for patients with grade l and ll hemorrhoids. Methods: Systematic review of Medline, Embase, Google scholar and Web of Science was performed between 01/1970 to 05/2023. Included articles were observational studies and clinical trials for adults >18 years old undergoing HET. The primary outcome was resolution of hemorrhoidal bleeding while secondary outcomes were improvement in pain, rate of recurrence of hemorrhoids and requirement for repeat treatment. Random effects model was used to calculated pooled prevalence in from the included studies. Results: 11 studies (5 prospective cohorts, 3 case series, 2 retrospective cohorts and 1 randomized controlled trial (RCT)) were included from 10/2013 to 08/2021, comprising 563 patients. Mean age for undergoing HET was 54.3 years and 52.8% were females. Baseline characteristics are in Table 1. Of 414 patients with bleeding, 374 had improvement or resolution of bleeding with a pooled response rate of 91.4% (95% Confidence Interval (CI) 87.87-95.01), I2 = 30.25% (Figure 1a). Of 262 patients with pain, 237 patients reported improvement. The pooled response rate was 91.90% (95% CI 88.63-95.18, I2 = 0) (Figure 1b). 46/334 patients had refractory/recurrent hemorrhoids. 33/262 underwent repeat intervention (HET/non-HET methods). Adverse events are in Table 1. The only controlled study was a 2019 RCT (Filgate et.al), comparing HET to rubber band ligation (RBL), showing HET being as effective as RBL in treating symptoms; with a lower 1-hr post-operative pain score (mean 10-point pain score 1.5 vs 5.5, P < 0.05). Conclusion: More than 90% of patients who underwent HET experienced improvement in bleeding and/or pain, though certainty of evidence is low. There are limited controlled studies comparing HET to other endoscopic procedures. Study limitations include publication bias and small sample size. Given the promising efficacy with low adverse events, further controlled studies comparing HET to other methods, with a focus on patient satisfaction, immediate and delayed bleeding, pain and recurrence are warranted.Figure 1.: (a): Pooled Response Rate for Improvement/Resolution of Bleeding Post-HET; (b): Pooled Response Rate for Improvement of Pain Post-HET. Table 1. - Baseline Characteristics and Adverse Events Post-HET Baseline Characteristics Percentage (%) Sex Female 52.8% Country United States 97.5% New Zealand 2.5% Type of Analgesia/Sedation None 5.4% Local Anaesthesia 18.1% Moderate Sedation 51.2% General Anaesthesia 1.5% Grade of Hemorrhoids Grade I 50.9% Grade II 46.6% HET Type Standard 81.3% Modified 6.6% Medtronic Anoscopy 10.9% Adverse events at Longest Follow up Infection 0% External Hemorrhoids 1.9% Fissures/Fistula 2.5% Fecal Incontinence 1.6%