Band Ligation Technique Research Articles

Outcomes of Rubber Band Ligation in Haemorrhoids Among Outdoor Patients.

Out of all anorectal diseases, haemorrhoids are the most common benign disease. Haemorrhoids can be treated by various treatment modalities like medical, surgical, and instrumental. Instrumental treatment comprises rubber band ligation, sclerotherapy, and infrared and laser therapy. Out of these modalities, the rubber band ligation technique is the least invasive with a reduced rate of complications and without the need for hospitalization. Hence, the current study was conducted to evaluate the outcomes with respect to the effectiveness of rubber band ligation in grade II and III internal haemorrhoids along with the magnitude and pattern of post-procedural complications. This is a prospective observational study, conducted on a sample of 100 patients who presented to our outdoor patient's department and were diagnosed with haemorrhoids, either grade II or III. All enrolled study patients having haemorrhoids were banded with rubber band by Barron Ligator (Precise, Canada) with local anaesthetic agent xylocaine jelly in a single session. All patients were followed on the 10th day, 1st month, and 6th month after the procedure to assess symptomatic improvement. The endpoint of this study is to know the effectiveness of rubber band ligation in different clinical parameters such as post-ligation pain or discomfort, the requirement of analgesic, any complication, and time off work. Out of 100 patients 17 patients had grade II and 83 patients had grade III haemorrhoids. Among them, 89% were symptomatically relieved after rubber band ligation whereas the rest 11% of patients had residual symptoms. Thus, we conclude that rubber band ligation for grade II and III haemorrhoids is simple, safer, easy-to-perform daycare procedure with lesser requirements of analgesics and without any need for anaesthesia.

COMPARATIVE ANALYSIS OF BAND LIGATION TECHNIQUE VERSUS CONVENTIONAL HEMORRHOIDECTOMY FOR THE TREATMENT OF GRADE III HEMORRHOIDS

Objectives: A comparative study between band ligation technique and conventional hemorrhoidectomy for the treatment of Grade III hemorrhoids was carried out to compare operative and post-operative variables. Methods: This study was done on a sample size of 70 patients with Grade III hemorrhoids from 2019 to 2020 in the department of surgery of a medical college. Informed written consent was taken from the patients after explaining the benefits and side effects of both methods. The eligible patients were randomly divided into Group A (35 patients) for treatment by band ligation procedure and Group B (35 patients) who were treated by the conventional technique. The obtained data were subjected to statistical analysis by applying an unpaired t-test using SPSS 19.0 software. Results: The difference between the two groups of the average age was comparable. The operative time and intraoperative bleeding were significantly lower in Group A than in Group B. The time to first bowel movement (hr) and average hospital stay were significantly lower in Group A than in Group B. Furthermore, the average number of analgesic doses required was significantly lower in Group A than in Group B. Furthermore, the time required for wound healing was significantly lower in Group A. The overall complications were found to be quite less in Group A than in Group B. Conclusion: The rubber band ligation technique revealed better results in terms of operative and post-operative parameters as compared to the conventional hemorrhoidectomy.

Advanced Approaches to Rubber Band Ligation in Treatment of Hemorrhoidal Disease in the Elderly and Senile Outpatients

Introduction. Currently, rubber band ligation of internal hemorrhoids is performed during surgical treatment of hemorrhoids in 26,8844,0 % of cases. However, this technique can lead to the need for repeated interventions. Moreover, at stage IV hemorrhoids a relapse occurs in almost 40% of cases.The aim of the study was to improve clinical outcomes of the senile and elderly outpatients with stage II-III internal hemorrhoids by optimizing a rubber band ligation technique and indications for its use.Materials and methods. The authors analyzed clinical outcomes of 60 senile and elderly outpatients with stage II-III internal hemorrhoids. Patients were divided into 2 study groups. Patients of the control group received standard treatment including ligation of hemorrhoidal nodes with latex ligatures using a KARL STORZ suction ligature instrument with an integrated vacuum pump at a pressure equal 0.8 atm. Patients of the case group were exposed to ligation of hemorrhoidal nodes with latex ligatures using a KARL STORZ suction ligature instrument with an integrated vacuum pump at a pressure equal to 0,60,7 atm. Ligation in the case group was performed on the following conditions: high and medium degree of compliance in patients, hemorrhoids size less than 1,5 cm, absence of anemia, no antiplatelet drug intake a possibility to discontinue an antiplatelet drug in case it is takenResults. The study results demonstrated that 60 % of patients of the case group required pain relief on Day 1 after the intervention, 13,3% of patients of the case group required pain relief on Day 3 after the intervention. The correspondence to these parameters in the control group was 66,6% and 16,6% of patients respectively. The first defecation in patients of the case group occurred in 1,73 0,48 days on average; in patients of the control group in 1,74 0,47 days. Acute swelling of the external hemorrhoids was reported in 13,3% of patients of the case group and in 16,7% patients of the control group. Thrombosed external hemorrhoids, rectal bleeding, acute urinary retention were reported in 6,7% of patients of the case group and in 10,0% of patients of the control group. Vaso-vagal syndrome and local wound complications were reported in 6,7% of patients of the case group and in 3,3% of patients of the control group. Stricture of the anal canal was noted in 3,3% of patients of the case group and in 3,3% of patients of the control group. Anal sphincter incompetence was not detected in patients of the case group, while it was reported in 3,3% of patients of the control group. The average time of temporary disability was 2,3 0,4 days in patients of the control group and 1,9 0,4 days in patients of the case group. In 6 months after ligation, 60,0% of patients of the control group and 63,3% of patients of the case group manifested good results; 30,0% and 33,3% manifested satisfactory results; and 10,0% and 3,3% manifested unsatisfactory results respectively. After rubber band ligation, the relapse rate of the disease was 13,3% in patients of the control group and 10,0% in patients of the case group.Conclusion. Rubber band ligation is well tolerated by the senile and elderly patients. To reduce pain, tenesmus, vaso-vagal conditions, and urinary retention, the negative pressure created in the device sleeve degressed, which resulted in an improvement of patients general state and decrease in the number of complications.

Ligation assisted endoscopic mucosal resection of neuroendocrine tumor of duodenal bulb: a case report with a follow up of 24 months

Duodenal neuroendocrine tumor (NET) is a rare solitary lesion arising from the mucosa and submucosa of the duodenum, which is found incidentally during upper gastrointestinal endoscopy. Eendoscopic Mucosal Resection (EMR) has been the commonly used endoscopic procedure for duodenal carcinoid tumors, but the conventional EMR done to resect duodenal NET s is likely to have positive vertical margins. However, the ligation assisted EMR has recently been shown to be a promising technique for the treatment of duodenal NET that can have a negative free margin. In our study, we present a patient of 51-year-old male, who presented with pain over epigastrium and upper gastrointestinal endoscopy revealed a small submucosal lesion of 10 mm in the duodenal bulb. The endoscopic ultrasound showed the lesion arising from the echo layer three. The biopsy was taken which showed the duodenal NET. The computed tomography of abdomen did not show any evidence of distant metastasis. The EMR of duodenal NET was done by band ligation technique. The biopsy from the resected duodenal lesion confirmed the duodenal NET with the margin free of the tumor. The patient was followed at 6, 12, 18 and 24 months. During the follow up visits, the repeat upper gastrointestinal endoscopy did not show recurrence of the lesion and there was no any evidence of distant metastasis either. Ligation assisted EMR is an acceptable treatment in the hands of expert for small duodenal NET without the evidence of metastasis and can ensure the complete removal of the lesion with vertical free margin.

A comparative study of sclerotherapy and rubber band ligation versus open hemorrhoidectomy in second degree hemorrhoids

Background: Hemorrhoids affects the quality of life and leads to significant pain and discomfort. The current study was done to evaluate the results of comparative treatment of rubber band ligation, sclerotherapy and open hemorrhoidectomy.Methods: This was a prospective study done on 90 patients with second grade internal hemorrhoids attended to the Department of General Surgery at S. Nijalingappa Medical and Research Centre, Bagalkot during the study period from 2012 November to 2013 December. Systemic examination and basic investigations were done. According to severity and type of symptoms, patients are subjected for open hemorrhoidectomy (n=30), banding (n=30) and sclerotherapy (n=30).Results: Occurrence of hemorrhoids was seen between the age group of 36 to 45 years. Out of 90 patients 52 were males and 38 were females. Common presenting complaint was bleeding per rectum and mass per rectum in 33.33% of patients. Postoperative hospital stay was 1 day in the groups treated with rubber band ligation and sclerotherapy and in open hemorrhoidectomy 28 patients stayed for 3 days and 2 patients for 5 days. About 70% of patients belonging to rubber band ligation and sclerotherapy group gave excellent response to the same.Conclusions: In our study, rubber band ligation technique was found to be more cost effective and reliable to treat second grade hemorrhoids with lesser postoperative complications followed by sclerotherapy and hemorrhoidectomy.

Endoscopic Mucosal Resection of gastric dysplastic lesion by band ligation technique

No abstract

Endoscopic muscle biopsy sampling of the duodenum and rectum: a pilot survival study in a porcine model to detect myenteric neurons

Small bowel and colorectal muscle biopsy sampling requires a surgical approach. Advancing our understanding of the pathophysiology of motility disorders, such as functional bowel disorders, intestinal pseudo-obstruction, and slow-transit constipation, is hindered by our inability to noninvasively obtain muscularis propria (MP) for evaluation of multiple cell types, including myenteric neurons. The aims of this study were to determine (1) technical feasibility, reproducibility, and safety of performing duodenal endoscopic muscle biopsy sampling (dEMB) and rectal endoscopic muscle biopsy sampling (rEMB) using a clip-assist technique and (2) the presence of myenteric neurons in tissue samples. Five 40-kg pigs were studied. Each animal underwent a dEMB and rEMB procedure. dEMB was performed using a single resection clip-assist technique. An over-the-scope clip was advanced to the duodenum. Tissue was suctioned into the cap and the clip deployed. The pseudopolyp of the duodenal wall created was then resected using snare electrocautery. rEMB was performed using a double resection clip-assist technique. EMR was initially performed to uncover the underlying MP using a band ligation technique. An over-the-scope clip was then advanced to the exposed MP. The MP was retracted and suctioned into the cap and the clip deployed. The pseudopolyp of the MP was resected using snare electrocautery. An antibody to protein gene product 9.5 was used to determine the presence of myenteric neurons in the samples. Animals were kept alive for 2 weeks, at which time an upper endoscopy and necropsy were performed. dEMB and rEMB were successfully performed in all animals with no procedural adverse events using this "no hole" (close then cut) approach. Mean procedure times for dEMB and rEMB were 23.7 ± 2.5 minutes and 13.25 ± 2.8 minutes, respectively. Mean length of resected full-thickness duodenal wall was 13.25 ± 4.3mm and rectal MP was 12.5 ± 1.7mm. Hematoxylin and eosin stain and antibody to protein gene product 9.5 confirmed the presence of MP with inner circular, outer longitudinal, and intermuscular layers, including myenteric neurons, in all samples. Clinical course was uneventful in all animals. Repeat upper endoscopy at 2 weeks showed well-healed dEMB sites. Necropsy in all animals showed no perforation, fluid collection, or abscess at the dEMB and rEMB sites. Based on this preclinical study, dEMB and rEMB appear to be technically feasible, reproducible, and safe. Sufficient MP tissue was obtained to identify myenteric neurons. These promising results are a step toward successful and safe implementation of these techniques into clinical practice for tissue diagnosis of muscle-based pathologies.

Evaluation of Rubber band ligation technique for Internal Haemorrhoids

Introduction: Hemorrhoids are masses or clumps or “cushions” of tissues consisting of muscle and elastic fibres with enlarged, bulging blood vessels and surrounding supporting tissues present in the anal canal of an individual suffering from the disease. It is one of the common reasons for surgical OPD visit. In this study we tried to find out effectiveness of Ring band ligation technique 1st degree, 2nd degree & some of the 3rd degree hemorrhoids. Methods: All the patients coming to surgical OPD of tertiary care teaching hospital from June 2012 to December 2013 and diagnosed as a case of Hemorrhoids were included in study. Proctoscopic examination found to have first-, second-, and non-bulky, non edematous third-degree haemorrhoids were included for band ligation. Results: Out of total patients 202 were males and 145 were females. Bleeding per rectum (52%), discomfort during defecation (58%) and constipation (47%) were most common symptoms. Most common post-ligation/residual symptoms were bleeding (32 %), pain & discomfort (29.4 %) & constipation (21 %).70 % of patients are cured and 14 % have shown significant improvement. Conclusion: Rubber band ligation as first line treatment for 2nd degree lesion, however for 3rd degree lesion Open hemorrhoidectomy is always better.

Resection of carcinoids in the duodenal bulb using the band ligation technique with the Duette mucosectomy device

Resection of carcinoids in the duodenal bulb using the band ligation technique with the Duette mucosectomy device

Metastatic melanoma in an esophagus demonstrating Barrett esophagus with high grade dysplasia

BackgroundMetastatic melanoma involving the esophagus is rare; the occurrence of metastatic melanoma in a background of Barrett esophagus is rarer still. We report a case of an 80 year-old male who presented to our institution for workup of Barrett esophagus with high-grade dysplasia and who proved to have metastatic melanoma occurring in the background of Barrett esophagus, the first report of this kind, to our knowledge, in the English literature.Case presentationAn 80 year-old Caucasian male was diagnosed at an outside institution with Barrett’s esophagus with high grade dysplasia and presented to our institution for therapy. The patient underwent endoscopic mucosal resection using a band ligation technique of an area of nodularity within the Barrett esophagus. Microscopic examination demonstrated extensive Barrett esophagus with high-grade dysplasia as well as a second tumor which was morphologically different from the surrounding high-grade dysplasia and which was positive for S-100, HMB 45 and Melan-A on immunohistochemistry, consistent with melanoma. Further workup of the patient demonstrated multiple radiologic lesions consistent with metastases. Molecular studies demonstrated that the melanoma was positive for the 1799T>A (V600E) mutation in the BRAF gene. The overall features of the tumor were most consistent with metastatic melanoma occurring in a background of Barrett esophagus with high-grade dysplasia.ConclusionThis case demonstrates a unique intersection between a premalignant condition (Barrett esophagus with high grade dysplasia) and a separate malignancy (melanoma). This report also shows the utility of molecular testing to support the hypothesis of primary versus metastatic disease in melanoma.

Endoscopic mucosal resection of Barrett’s esophagus detects high prevalence of subsquamous intestinal metaplasia

To report the prevalence of Subsquamous intestinal metaplasia (SSIM) in patients undergoing endoscopic mucosal resection (EMR) for staging of Barrett's esophagus (BE). Thirty-three patients with BE associated neoplasia underwent EMR at our institution between September 2009 and September 2011; 22 of these patients met study inclusion criteria. EMR was targeted at focal abnormalities within the BE segment. EMR was performed in standardized fashion using a cap-assisted band ligation technique, and resection specimens were assessed for the presence of SSIM. Demographic and clinical data were analyzed to determine predictors of SSIM. SSIM was detected in 59% of patients. SSIM was detected in 73% of patients with short segment (< 3 cm) BE, and in 45% of patients with long-segment (≥ 3 cm) BE (P = NS). There was no association between presence/absence of SSIM and age, gender, or stage of BE-associated neoplasia. EMR detects SSIM in a majority of patients with BE-associated neoplasia. While the long-term clinical significance of SSIM remains uncertain, these results highlight the importance of EMR as an optimal diagnostic tool for staging of BE and detection of SSIM, and should further limit concerns that SSIM is purely a post-ablation phenomenon.

Loop-and-let-go technique for a bleeding, large sessile gastric gastrointestinal stromal tumor (GIST)

A 77-year-old woman was admitted for syncope followed by melena. She was under oral anticoagulant therapy for atrial fibrillation. An urgent upper endoscopy revealed active oozing of blood from an ulcer crater on the surface of a 3.5-cm, sessile submucosal tumor at the gastric fundus. Endoscopic hemostasis was achieved by epinephrine injection and application of hemoclips ([Fig. 1]). Although surgical gastric wedge resection is considered the gold standard treatment for such lesions ≥ 2 cm in size, since the patient presented a high risk for general anaesthesia and recurrent bleeding as well as the need of further anticoagulant therapy, we were forced to consider endoscopic treatment. Endoscopic snare resection and submucosal dissection are associated with a significant risk of perforation [1]. Endoscopic band ligation technique has been described as effective for smaller lesions [2]. Another alternative, the endoloop technique, has also been recently reported as potentially effective, provided the loop is tightened around the base of the lesion, which results in tissue strangulation and slow mechanical transection of a gastrointestinal stromal tumor (GIST), that is, ischemic necrosis followed by spontaneous sloughing [3].

Gastric Serrated Adenoma Polyp Treated With Endoscopic Band Ligation (With Video)

Serrated adenoma of the stomach has been very rarely reported. A 34-year-old woman underwent upper gastrointestinal endoscopy showing a serrated adenoma polyp at the posterior wall of the junction of the fundus and body of the stomach. The polyp was situated in a technically difficult area to perform a polypectomy with a snare. A banding ligation of the polyp was performed with a pneumoactivated esophageal variceal ligation device. At the follow-up, the base of the polyp was free of adenoma. Beside several other polypectomy techniques, the band ligation technique may be used in removing of the gastric polyps, which is cheap, safe and technically easy to perform.

Circumferential endoscopic mucosal resection of a 14-cm Barrett's dysplasia with the Duette mucosectomy device (with videos)

Barrett's esophagus (BE) is associated with a 30- to 50-fold increased risk for development of esophageal adenocarcinoma.1,2 For Barrett's high-grade dysplasia (HGD) and mucosal cancer, endoscopic ablation such as EMR is emerging as a viable option for potential cure.2,3 In EMR, the “suck and cut” technique uses either a transparent cap (“lift and cut” method) or a band ligator hood (“ligate and cut”) method.4,5 The “suck and cut” method is the most commonly practiced method for esophageal EMR. The band ligation technique often uses the multiband ligator to place bands on flat mucosa creating a “pseudopolyp” followed by resection with an electrocautery snare.

Rubber-band ligation for hemorrhoids in a Colorectal Unit: A prospective study

Nowadays the rubber band ligation technique is one of the most worldwide used and effective treatment of the hemorrhoidal disease. Our study has as a goal to analyze the success or failure of the rubber band ligation in hemorrhoids grade 1,2 and 3, to analyze their complications and to see if all symptomatic hemorrhoids should be treated with ligation at the first visit. A prospective and descriptive study was designed for patients who came to the Colorectal Unit with hemorrhoidal disease from September 1997 to December 2001. First, second and third degree patients were treated according to the classification of hemorrhoids of St. Mark's Hospital. The technique of ligation after Barron was applied. From 261 patients with a mean age of 48.3 (range: 16-86), 181 (99 M/82 W) have been treated with Barron's method and 80 with rich fiber diet and water. Rectal bleeding was the most common symptom (91.16%). Anuscopy showed hemorrhoidal disease in all the cases. From 181 patients, 19.33% were hemorrhoids degree I, 51.93% degree II and 29.83% degree III. Two hundred and eighty-seven ligation sessions were done and the balance of ligations per patient was 2.45 and 1.5 rubber band per session. The 32% of the patients referred pain after ligation. A 13.81% of cases were operated due to persistent rectal bleeding or hemorrhoidal prolapse. Symptomatic hemorrhoids degree I and II with a short clinical history should be treated initially with a rich fiber and water diet. The technique of Barron is an effective therapy to treat the hemorrhoids degree 1, 2 and in 74% of success in cases with degree 3.

Combo cap takes a big bite, yet a smoothie to swallow

Combo cap takes a big bite, yet a smoothie to swallow

Endoscopic Mucosal Resection of the Esophagus

Endoscopic mucosal resection (EMR) is a minimally invasive endoscopic technique used in treating superficial cancers of premalignant lesions in the gastrointestinal tract. An attraction of this technique is that it can be curative with low morbidity, often providing the entire lesion for pathologic evaluation. The band ligation technique of EMR uses the existing technology of variceal band ligation to endoscopically place a band on flat mucosal lesions of the gastrointestinal tract to create a "pseudopolyp" before resection with an electrocautery snare. The band ligating technique and two variant band ligating devices are described.