Long-term Efficacy and Safety of Aluminum Potassium Sulfate and Tannic Acid (ALTA) Injection as Sclerotherapy for Internal Hemorrhoids in Patients with Systemic Diseases in University Hospitals

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Objective: Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for internal hemorrhoids, which is characterized by minimal invasiveness and early hemostasis, is an alternative to surgical treatment for high-risk patients with hemorrhagic diathesis. We evaluated its long-term efficacy and safety.<BR>Methods: 118 patients with internal hemorrhoids (75 cases with Goligher grades III-IV), including 29 cases with hemorrhagic diathesis and 10 cases with other systemic diseases, were treated under lower lumbar or local anesthesia. Improvements in hemorrhage, pain and prolapse, and score on a 5-point satisfaction scale, were assessed at 2 weeks and 3 months.<BR>Results: The ALTA dosage, hospital days and adverse events were not influenced by systemic risks. The symptoms disappeared in almost 90% of cases after 3 months, with a satisfaction score of 4.7±0.7. Recurrence was seen in 11% of cases (20-month median follow-up). Re-bleeding (P = 0.06) and re-prolapse (P = 0.03) were frequently observed in patients with hemorrhagic diathesis. Disappearance of re-bleeding (91%) and re-prolapse (82%) were observed, with a satisfaction score of 3.9±1.4, three months after re-injection of ALTA.<BR>Conclusion: ALTA sclerotherapy is safe for high-risk patients and also effective for recurrence.