A retrospective study investigated the efficacy and safety of combined endoscopic rubber band ligation (ERBL) in the treatment of grade II-III prolapsed internal hemorrhoids. degree in patients from January 2019 to June 2023. The participants were 124 patients. Complete disappearance of symptoms reached 91.85% of cases, partial disappearance in 5.19% and recurrence in 2.96%. Anal pain after the procedure occurred in 25.19% of patients with a mean VAS score of 0 (0–3). They recorded postoperative bleeding in 13.33% of cases, anal swelling in 14.07% and urinary retention in 2.96%. Ligation of three hemorrhoids resulted in a higher incidence of pain (30.43% vs. 11.6%, P=0.018) and a higher VAS score (P=0.003) versus two hemorrhoids, with no difference in long-term efficacy. Male (OR 5.654, 95% CI 1.222–26.159; P=0.027) and postoperative complications (OR 4.914, 95% CI 1.080–22.345; P=0.039) were risk factors for incomplete healing. Combined ERBL is an effective and safe method.