Leech therapy for grade III internal hemorrhoids: a randomized pilot study comparing leech application with rubber band ligation
Sahin M, Kara M, Aktaş G, Kayadibi H (2017) · Journal of Coloproctology · n=44
RCT evidence detailTrial reference
Study Profile
- Design
- single-center, open-label, randomized pilot trial (Ankara)
- Sample size (n)
- 44
- Intervention
- Two sessions of 3-5 Hirudo medicinalis leeches at the external hemorrhoidal margin, 7 days apart
- Comparator
- Rubber band ligation (RBL), one session, standard technique
- Primary endpoint
- Symptom severity score (bleeding, prolapse, pain) at 4 weeks
- Primary result
- Symptom score reduction 64% in leech vs 71% in RBL at week 4 (between-group p=0.42); pain during procedure: VAS 2.8 in leech vs 5.4 in RBL (p<0.001)
- Effect size (Cohen's d)
- 0.21
- Follow-up duration
- 12 weeks
Key Findings
- First (and to date only) RCT of leech therapy for hemorrhoids
- Symptom outcomes statistically equivalent to RBL
- Procedural pain markedly less in leech arm (2.8 vs 5.4 VAS)
- Patient acceptability higher in leech arm
- Recurrence at 12 weeks: 18% in leech vs 5% in RBL (numerically worse, not significant given small sample)
Limitations
- Small sample (n=44)
- Higher numerical recurrence in leech arm — possible inadequate definitive treatment
- Open-label
- Single center
- Excluded grade IV hemorrhoids — generalizability narrow
Clinical Implications
Sahin 2017 is the only RCT for hirudotherapy in hemorrhoids. The clinical message is mixed: equivalent symptom relief and better procedural tolerability, but possibly higher recurrence. For low-risk grade III hemorrhoids in patients who refuse instrumentation, leech therapy is a defensible alternative pending further confirmation. The trial is best understood as a feasibility study rather than definitive evidence.