Evidence-based ALTA Therapy as a Radical Treatment for Hemorrhoids

Abstract

Aluminum potassium sulfate and tannic acid (ALTA) are able to induce noninvasive sclerosis and involution of hemorrhoids through initiation of inflammatory reaction. ALTA therapy is an effective treatment for all cases of internal hemorrhoids, but not all cases of hemorrhoids are treatable by ALTA therapy alone. The current treatment strategy for internal hemorrhoids at our hospital is based on (1) determination of whether ALTA therapy is possible for the given type of hemorrhoid, and (2) ligation and excision (LE) of those types for which ALTA therapy is difficult to perform.
Between May 2006 and May 2010, 1,630 patients with grade II to IV hemorrhoids underwent surgery at Kunimoto Hospital.
A total of 645 patients were treated with ALTA therapy alone (Group A), 912 patients received a combination of LE and ALTA therapy (Group B), and 73 received LE alone (Group C). The overall recurrence rate was 2.8% (18/645) and 0.4% (4/912) in Group A and B, respectively. There was no recurrence in Group C. In Group A, 9 patients required an additional injection therapy procedure, and 6 required LE. In Group B, 2 patients required LE. Five patients (0.8%) had rectal ulcers to the injection site in Group A. These patients were cured by conservative therapy for several months.
ALTA injection is an effective, established treatment for internal hemorrhoids. ALTA sclerotherapy is a simple and safe treatment for the management of symptomatic hemorrhoids and has few complications.