Investigating the Follow-up Period after ALTA Sclerotherapy Using Transanal Ultrasonography

OBJECTIVES: This study aims to clarify the appropriate follow-up period after aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for internal hemorrhoids by transanal ultrasonography. METHODS: Forty-four patients (98 lesions) who underwent ALTA sclerotherapy were analyzed. Transanal ultrasonography was performed pre and post-ALTA sclerotherapy to observe the thickness and the internal echo image of hemorrhoid tissue. Patients who developed complications were excluded. RESULTS: No recurrence in 12 months was observed in 44 patients. After 1-3 months of ALTA sclerotherapy, hemorrhoids were observed in the low-echo imaging region. During this period, hemorrhoidal tissue was observed thickest by granulation. Moreover, hemorrhoid tissue contracted by fibrosis formed 5-7 months post-ALTA sclerotherapy, with a thinner hemorrhoid. Furthermore, hemorrhoids hardened and regressed with intense fibrosis 12-months after the therapy and eventually became thinner than pre-ALTA sclerotherapy. CONCLUSIONS: After ALTA sclerotherapy, the suggested follow-up period with and without the development of complications is ～6 and ～3 months, respectively.