Reply to Alberto et al.

We thank Dr Alberto and her colleagues for their interest in our article, and read with interest their letter about the treatment of the disease with rubber bands and sclerotherapy. In our cases we have also tried ligation with the Stiegmann-Goff ligator, but this has not been very effective because of the extensive size of the lesions. We found loop ligation (Olympus) to be more efficient although we did have difficulty in positioning the loops around the lesion, as they slipped off easily. In our experience, cyanoacrylate was the best treatment, as it rapidly obliterated the bleeding lesions, reduced their size, and diminished the intensity of bleeding.

We agree that misdiagnosis is common, as it was in our case and Dr Alberto’s. In our opinion, if radical sphincter-preserving surgery is not possible, endoscopic therapy should be tried, even if it is only moderately efficient, as this may protect the patient from the disability associated with colostomy. Dr Alberto’s patient was lucky that the hemorrhoid treatment was efficient, and made her asymptomatic for at least 1 year. It would be interesting to learn of this patient’s future progress.

Competing interests: None