Hemorrhoids are one of the common diseases in anus and intestines, and injection therapy is a commonly used treatment, but there is a lack of national data on the depth and standardized application of injection therapy, so it is necessary to carry out this research study.

To investigate the depth and breadth, standardized application, effectiveness and safety of hemorrhoidal injection therapy and the reasons for its failure to be carried out in China.

An online questionnaire was issued to the members of the Professional Committee of Anal and Intestinal Diseases of the Chinese Association for Medical Education from July to November 2022, and the content of the questionnaire was designed by ourselves, with a total of 37 questions, including demographic information, methods of treating hemorrhoids, the application of injectable treatments, and complications, etc. The data were statistically analyzed using SPSS 21.0 software.

A total of 335 questionnaires were recovered and 312 questionnaires were valid (93.1% recovery rate). There were 293 (93.9%) doctors using sclerotherapy, 153 (54.2%) doctors implementing more than 500 cases of injection therapy, and the difference was not statistically significant when comparing the number of injection therapy carried out by anorectal doctors of different hospital levels, hospital natures, and types of hospitals (P>0.05). 293 (93.9%) and 263 (84.3%) doctors believed that injection therapy was suitable for the treatment of internal hemorrhoids and the internal portion of mixed hemorrhoids. For internal hemorrhoids of degree Ⅰ and Ⅱ, the percentage of sclerotherapy injection was 55.4% (173/312) and 79.2% (247/312), respectively. For the choice of anesthesia, local anesthesia was predominant in 229 (73.4%) and lumbar anesthesia in 145 (46.5%) cases. Sclerotherapy was applied in 280 (89.7%), accounting for the first use of sclerotherapy; 201 (64.4%) chose to treat three hemorrhoids in a single treatment, and for hemorrhoids in the anterior part of the anus, 140 (44.9%) of the physicians thought that they could be injected, while 172 (55.1%) thought that sclerotherapy should not be injected. Dosage analysis showed that anti-hemorrhoidal sclerotherapy single site injections were concentrated at 1-5 mL in 80.7% (92/114) and low-dose (0-3 mL) regimens in 56.7% (59/104) of cases; despite the fact that 233 (74.7%) endorsed the curative properties of injections alone, 227 (88.8%) of the clinical practices combined the procedures, with hemorrhoidectomies accounting for 64.7% (202/312) of the cases. The 1-year recurrence rate of <10% assessed for injection alone amounted to 90.3% (233/258), but decreased to 58.9% (146/248) at the 5-year assessment; the complication rate of patients treated with injections showed anal pain in 134 (42.9%), urinary retention in 90 (28.8%), and hardness at the injection site in 182 (58.3%), which were the common complications. Other serious complications included perianal abscess (5.1%, 16 cases), sepsis (1.3%, 4 cases) and rectal perforation (1.6%, 5 cases). The main reasons for not carrying out injection therapy were cited by 15 (35.7%) as hospital management factors, 9 (21.4%) as price, 8 (19.0%) as questionable efficacy, and 6 (14.3%) as drug shortage.

Hemorrhoid injection therapy has been widely recognized and applied by anorectal physicians in China, with 93.9% of physicians carrying out this therapy, more than 54.2% operating more than 500 cases, and the popularity of this therapy did not differ significantly among all levels and types of hospitals. At least 55.4% of doctors can standardize the indications (Ⅰ-Ⅱ degree internal hemorrhoids are more inclined to use injection treatment). Anti-hemorrhoidal spirit is the most commonly used sclerosing agent, and more than 3 hemorrhoid nuclei are injected at one time. Hemorrhoidal injection therapy is efficacious, with 90% of physicians reporting a 1-year recurrence rate of <10%, and long-term recurrence rate data supporting its reliability. Nearly 90% of physicians preferred to combine with other procedures, reflecting a lack of confidence in injections alone and the need to clarify the "symptomatic relief" goal of device therapy and improve patient communication. Hemorrhoidal injection therapy as a safe and effective hemorrhoidal management tool is suitable for national promotion, but needs to strengthen the operation standardization training and complication prevention and control system construction.