The incidence of internal hemorrhoids is high. Internal hemorrhoids often cause hematochezia. Medication and minimally invasive surgery are effective therapies for internal hemorrhoids, but these two treatments have high rates of recurrence.

To evaluate the efficacy of a Chinese medicine, Huazhi suppository, combined with cap assisted endoscopic sclerotherapy (CAES) for symptomatic internal hemorrhoids and its long-term recurrence rate.

This study selected 104 patients (older than 18 years) with grade Ⅰ-Ⅲ internal hemorrhoids admitted to Guangdong Provincial People's Hospital from January 2018 to June 2020. These patients were randomly assigned into 3 groups by using the single-blind envelope method: medication group (n=31) , CAES group (n=38) and combined group (n=35) . Patients in the medication group received one Huazhi Suppository per time, twice daily for 7 days. Patients in the CAES group received sclerosing agent injection into the hemorrhoidal vein or hemorrhoids exposed by a short transparent cap under the direct vision of flexible endoscope. Patients in the combination group received one Huazhi Suppositoryper time, twice daily for 7 days after the CAES treatment. This study collected the data about clinical efficacy, complications and the satisfaction degree of these three groups, and followed up the recurrence of internal hemorrhoids at one year after treatment.

The rates of overall symptom remission in medication group, CAES group and combined group were 71.0% (22/31) , 100.0% (38/38) and 100.0% (35/35) , respectively. The CAES group and combined group had significant higher rates of overall symptom remission compared with medication group (P<0.001) . The remission rates of hematochezia, perianal discomfort and defecation difficulty were significantly higher in the CAES group and combined group compared with the medication group (P<0.01) . There were no severe adverse events among these three groups. One year after treatment, the recurrence rates of internal hemorrhoids in the medication group, CAES group (n=38) and combined group were 36.4% (8/22) , 15.8% (6/38) and 8.6% (3/35) , respectively. The combined group had lower recurrence rate compared with medication groups (P=0.015) . The satisfactory rates in medication group, CAES group and combined group were 48.4% (15/31) , 78.9% (30/38) , 88.6% (31/35) , respectively. The CAES group and combined group had higher rates of satisfaction compared with the medication group (P<0.05) .

The short-term efficacy of CAES combined with Huazhi Suppository equals to that of CAES group, but better than that of medication group. The long-term recurrence rate of combination group was lower than that of CAES group. We may recommend using CAES combined with Huazhi Suppository.