Efficacy and Safety of Topical vs. Oral Calcium Channel Blockers for Chronic Anal Fissures: A Systematic Review and Meta-Analysis

Li Tianshuo¹Pengfei Ye¹Xinli He¹Chen Li¹Lanlan Xi¹Zuowu Xi^2*

• ¹The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
• ²Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, China

Background: Calcium channel blockers (CCBs) are first-line pharmacotherapy for chronic anal fissures (CAF), but the optimal administration route (oral vs. topical) remains unclear. This systematic review and meta-analysis compared efficacy and safety of oral vs. topical CCBs for CAF. Methods: PubMed and Embase were systematically searched from inception through February 2025 for relevant randomized controlled trials (RCTs). Two reviewers independently performed study selection, quality assessment, and data extraction. Random-effects models were used to pool effect sizes, with sensitivity analyses to assess robustness. The quality of evidence was assessed using the GRADE approach. Results: Four RCTs (279 patients) were included. Topical CCBs significantly reduced unhealed fissure risk vs. oral CCBs (OR = 2.65, 95% CI = 1.50–4.69 , moderate certainty evidence), with comparable recurrence rates (based on limited data from 3 studies). Initial side effect analysis showed no difference, but sensitivity analysis excluding a high-bias trial revealed fewer adverse events with topical CCBs (OR = 13.16, 95% CI = 5.05–34.3, moderate certainty evidence). Conclusions: Based on limited evidence, topical CCBs may offer superior healing rates and safety profiles vs. oral formulations for CAF, with similar recurrence rates, though additional high-quality studies are needed to confirm these findings.