Elastic Band Ligation Research Articles

Profilaxis secundaria mediante ligadura con bandas elásticas en varices esofagogástricas

The aim of the present study was to determine the usefulness of elastic band ligation in the prevention of hemorrhage recurrence due to esophageal-gastric varices. Sixty-five patients who survived an episode of variceal hemorrhage were included in the study. Twenty-nine patients (45%) were Child-Pugh class A, 25 (38%) were class B, and 11 (17%) were class C. The cause of cirrhosis was hepatitis C virus and alcohol in 45% and 31% of the patients, respectively. The first ligation session was performed between the third and fifth day after the hemorrhagic episode and subsequent sessions were carried out at intervals of 3-4 weeks. The ligation sessions were performed with antibiotic prophylaxis. A mean of 2.7 bands were placed per session (range 1-5), and the mean number of sessions required per patient to achieve variceal eradication was 2.5 (range 1-6). The rate of bleeding recurrence was 24.6% (16 episodes). In conclusion, endoscopic elastic band ligation is a useful technique for the eradication of esophageal varices and for the prevention of bleeding recurrence.

Elastic band ligation of hemorrhoids: flexible endoscope versus rigid proctoscope

Elastic band ligation of hemorrhoids: flexible endoscope versus rigid proctoscope

Elastic band ligation of haemorrhoids: a new applicator.

Elastic band ligation of haemorrhoids: a new applicator.

Treatment of variceal bleeding in patients with cirrhosis of the liver

AbstractGastroesophageal variceal bleeding is a complication of liver cirrhosis with a mortality rate of 20% at 6 weeks. Initial treatment includes blood volume restitution, antibiotic prophylaxis, and administration of vasoactive drugs to decrease portal pressure with the aim to arrest the bleeding and prevent rebleeding. Effective drugs include terlipressin and somatostatin, which should be started at admission and maintained for 2–5 days. Early endoscopic diagnosis (<12 hours) is mandatory. If variceal bleeding is confirmed endoscopic elastic band ligation (or injection sclerotherapy if banding is not possible) should be administered, but vasoactive drugs should not be withdrawn. Failures of combined medical therapy (drugs plus endoscopic therapy) should be evaluated for transjugular intrahepatic portosystemic shunt or portosystemic shunt surgery.

Mechanical Modalities of Endoscopic Therapy: Clips, Loops, and Beyond

Mechanical methods of endoscopic hemostasis are rapidly gaining acceptance due to their efficacy and safety. Nonetheless, some problems still exist as to their general applicability since both clipping and banding are technically demanding procedures which depend on the operator’s expertise and team trained approach. Improvements in clip design and materials, together with progress in the loading and release systems will hopefully lead to the more widespread use of such mechanical methods with the aim of preventing recurrent bleeding. Elastic band ligation is a relatively simple procedure whose application in the management of nonvariceal bleeding has recently expanded to include selected patients with peptic ulcer bleeding.

Endoscopic Identification of a Gastric Dieulafoy’s Lesion Following Ephedrine Administration

The diagnosis of Dieulafoy’s lesions may be difficult even for experienced endoscopists [1]. Nearly one-third of patients who have bleeding from Dieulafoy’s lesions require repeated endoscopic examinations before a conclusive diagnosis can be reached [2]. Failure to diagnose this condition is mainly due to the absence of active bleeding or stigmata of recent hemorrhage during endoscopy (bleeding from Dieulafoy’s lesions is often intermittent) [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13]. This report describes a case in which on two occasions, the administration of ephedrine to treat propofol-induced hypotension during gastroscopy was followed by the appearance of active bleeding from a gastric Dieulafoy’s lesion that had not been identified on previous endoscopic and angiographic studies. This allowed endoscopic diagnosis of the Dieulafoy’s lesion and successful treatment by elastic band ligation.

Treatment of variceal bleeding in patients with cirrhosis of the liver

Gastroesophageal variceal bleeding is a complication of liver cirrhosis with a mortality rate of 20% at 6 weeks. Initial treatment includes blood volume restitution, antibiotic prophylaxis, and administration of vasoactive drugs to decrease portal pressure with the aim to arrest the bleeding and prevent rebleeding. Effective drugs include terlipressin and somatostatin, which should be started at admission and maintained for 2–5 days. Early endoscopic diagnosis (<12 hours) is mandatory. If variceal bleeding is confirmed endoscopic elastic band ligation (or injection sclerotherapy if banding is not possible) should be administered, but vasoactive drugs should not be withdrawn. Failures of combined medical therapy (drugs plus endoscopic therapy) should be evaluated for transjugular intrahepatic portosystemic shunt or portosystemic shunt surgery.

Hemorrhoidal elastic band ligation with flexible videoendoscopes: a prospective, randomized comparison with the conventional technique that uses rigid proctoscopes

Elastic band ligation by means of a rigid proctoscope is the treatment of choice for patients with symptoms caused by internal hemorrhoids of grade 2 to 3. In contrast to the flexible videoendoscope, the rigid proctoscope has limited maneuverability, has a narrower field of view, and does not allow adequate documentation. Therefore, a randomized trial was conducted to compare the safety and the efficacy of conventional elastic band ligation with videoendoscopic elastic band ligation. A total of 100 consecutive patients (mean age 47 [12] years) with chronically bleeding grade 2 or 3 internal hemorrhoids were randomized to elastic band ligation or videoendoscopic elastic band ligation. For videoendoscopic elastic band ligation, a reusable multiband ligator was attached to the end of a therapeutic upper videoendoscope. From one to 3 bands were placed per session in both groups. Re-treatment was performed every 2 to 3 weeks in both groups until cessation of bleeding and eradication of the hemorrhoids (at least grade 2) were achieved. Thereafter, the patients were followed to assess complications and efficacy. Recurrent bleeding was considered a treatment failure. To achieve the desired therapeutic aims, a significantly lower number of treatment sessions was required in the videoendoscopic elastic band ligation group (1.8 [0.8] vs. 2.4 [0.9]; p < 0.01) and the total number of bands applied was significantly less (2.8 [1.1] vs. 3.7 [1.4]; p < 0.01). Pain was noted after ligation by 25% of patients in the elastic band ligation group compared with 27% of those who had videoendoscopic elastic band ligation. However, analgesic medications were required in only 7% after elastic band ligation and 9% after videoendoscopic elastic band ligation (NS). Post-ligation bleeding that had to be treated endoscopically occurred in 3.5% of the patients of the elastic band ligation group and 3.2% of those in the videoendoscopic elastic band ligation group (NS). Blood transfusion was not required. At a median follow-up of 12 months, there was no recurrence of bleeding in 40 patients (80%) in the conventional elastic band ligation group vs. 43 (86%) in the videoendoscopic elastic band ligation (NS). The long-term efficacy and safety of conventional elastic band ligation and videoendoscopic elastic band ligation are highly comparable. However, when videoendoscopic elastic band ligation is performed, significantly fewer treatment sessions are required.

Detachable endoloop vs. elastic band ligation for bleeding esophageal varices

Background Variceal bleeding is a serious complication with a mortality rate that ranges from 20% to 50%. Patients who have variceal hemorrhage usually are treated by endoscopic injection sclerotherapy or elastic band ligation to eradicate the varices. Endoloop ligation is a newly developed technique for achieving hemostasis and variceal eradication. This study compared endoloop ligation with elastic band ligation in patients with acute esophageal variceal bleeding. Methods Fifty patients with acute esophageal variceal bleeding were recruited: 25 were treated by elastic band ligation and 25 by endoloop ligation. Results Although the number of patients in whom bleeding recurred during a follow-up period of 6 months was smaller in the endoloop group (12%) vs. the band group (28%), this difference was not statistically significant. Furthermore, no statistically significant difference was found between the two groups with respect to the number of patients in whom variceal eradication was achieved, the number of treatment sessions required for variceal eradication, or the frequency of variceal recurrence. The total cost for variceal obliteration by endoloop ligation was $342 per patient, whereas, the total cost of variceal eradication by elastic band ligation was $356 per patient. The endoloop had certain technical advantages over band application: a better field of vision, tighter application, good results with junctional varices, and a lack of strain exerted by the device on the endoscope. Conclusions Endoloop ligation is a promising new technique for management of patients with bleeding esophageal varices.

Retroflexed endoscopic multiple band ligation of symptomatic internal hemorrhoids

Background Elastic band ligation is a well-established nonoperative method for treatment of internal hemorrhoids that give rise to symptoms. This study assessed the efficacy and safety of retroflexed endoscopic multiple band ligation, a procedure that involves extensive ligation of internal hemorrhoids, and the immediately proximal normal rectal mucosa, by means of a retroflexed endoscope. Methods Eighty-two patients with symptoms caused by internal hemorrhoids (15, stage I; 19, stage II; 47, stage III; 1, stage IV) were treated by retroflexed endoscopic multiple band ligation. Symptoms (prolapse, bleeding, pain with defecation) were graded from 0 to 3. Range and form of the internal hemorrhoids were evaluated endoscopically. Retroflexed endoscopic multiple band ligation was performed by using a flexible endoscope with an attached band ligation device in the retroflexed position. Results A mean of 8 bands (range 4-14) were placed per treatment session. Seventy-six patients were treated in a single session, 5 in two sessions, and one in 3 sessions. Symptom and endoscopic scores improved at 4 weeks after the retroflexed endoscopic multiple band ligation: bleeding, from 1.26 to 0.53 ( p<0.01); prolapse, from 1.94 to 0.5 ( p<0.01); pain, from 1.03 to 0.93 ( p = 0.67); Goligher classification, from 2.41 to 1.09 ( p<0.01); range, from 3.25 to 0.56 ( p<0.01); and form, from 2.81 to 0.56 ( p<0.01). Long-term response (mean follow-up 12 months, range 3-40 months) was excellent for 89% of the patients, good for 9%, and poor for 2%. No major complication was noted. Conclusions Retroflexed endoscopic multiple band ligation is a safe and effective method for treatment for patients with symptoms caused by internal hemorrhoids.

Medical management of variceal bleeding in patients with cirrhosis.

Bleeding from gastroesophageal varices is a frequent and often deadly complication of cirrhosis. The key factor in the natural history of esophageal varices is increased portal pressure, which in cirrhosis is due to the combination of increased hepatic vascular resistance and increased portal collateral blood flow. The maintenance and aggravation of this situation leads to the progressive dilation of the varices and thinning of the variceal wall, until the tension exerted by the variceal wall exceeds the elastic limit of the vessel, leading to variceal hemorrhage. Mortality from a variceal bleeding episode has decreased in the last two decades from 40% to 20% due to the implementation of effective treatments and improvement in the general medical care. Initial treatment should include adequate fluid resuscitation and transfusion to maintain the hematocrit at 25% to 30%, and prophylactic antibiotics (norfloxacin or amoxicillin-clavulanic acid). It is currently recommended that a vasoactive drug be started at the time of admission. Drug therapy may be started during transferal to hospital by medical or paramedical personnel and maintained for up to five days to prevent early rebleeding. Terlipressin, a vasopressin derivative, is the preferred agent because of its safety profile and proven efficacy in improving survival. Somatostatin is as effective as terlipressin, but may require higher than the usually recommended dosage. Octreotide is effective in conjunction with endoscopic therapy, but is the second choice because it has not been shown to reduce mortality. Vasopressin may be used where terlipressin is not available, but should be given in combination with transdermal nitroglycerin. Endoscopic elastic band ligation is the recommended endoscopic treatment, but injection sclerotherapy is still employed in many centres for active variceal bleeding. Failures of medical therapy (drugs plus endoscopic therapy) should undergo a second course of endoscopic therapy before proceeding to transjugular intrahepatic portosystemic shunt or, in rare occasions, to portosystemic shunt surgery. Administration of recombinant activated factor VII may decrease the number of treatment failures among patients with advanced liver failure (Child-Pugh class B and C).

Retroflexed endoscopic band ligation of bleeding internal hemorrhoids

Background: Elastic band ligation is a well-established nonoperative method for treatment of bleeding internal hemorrhoids, stages II-III. Usually, one or two bands are placed at a single session by using rigid instruments. The aim of this study was to assess the feasibility, tolerability, safety, and efficacy of multiple band ligation of internal hemorrhoids performed in one session by using a flexible endoscope with an attached band ligation device in the retroflexed position. Methods: Eighty-three patients with chronically bleeding and/or prolapsing internal hemorrhoids were treated by retroflexed endoscopic band ligation. From 1 to 6 bands were placed in a single session. Bands were targeted at the apex and proximal body of the internal hemorrhoid so that final band placement was entirely proximal to the dentate line. Malpositioned bands were removed by using a novel method. Patients were followed prospectively to assess tolerance, complications, and efficacy. Retreatment was offered if the desired result was not achieved. Results: A mean of 3.0 (SD 1.2) bands (range 1-6) were placed in a single session. Five percent of bands were malpositioned and removed. Patients were followed for 26 (17) months (range 1-52 months). An excellent result was achieved in 80% of patients with stage II hemorrhoids. Patients with stage II hemorrhoids were more likely to have an excellent result compared with patients with stage III hemorrhoids (80% vs. 54%, p < 0.01). Retroflexed endoscopic band ligation was well tolerated overall. The rate of major, nonfatal complications was 4%. Conclusions: Retroflexed endoscopic band ligation is a feasible, well-tolerated, effective, and safe for treatment of bleeding stage II internal hemorrhoids. A novel method of endoscopic band removal is described. (Gastrointest Endosc 2002;55:532-7.)

Endoscopic Sclerosis versus Cyanoacrylate Endoscopic Injection for the First Episode of Variceal Bleeding: A Prospective, Controlled, and Randomized Study in Child-Pugh Class C Patients

Despite the recognized efficacy of sclerotherapy and elastic band ligation in controlling variceal hemorrhage, the results of endoscopic treatment in Child-Pugh class C patients remain poor. The aim of this prospective, controlled, and randomized study was to compare conventional sclerotherapy with injection of the tissue adhesive N-butyl-2-cyanoacrylate in controlling the first episode of rupturing of esophageal varices. From January 1994 to June 1997, 36 consecutive Child-Pugh class C cirrhotic patients were admitted with an initial episode of esophageal variceal bleeding. They were randomly assigned to receive sclerotherapy with a 3% ethanolamine oleate solution (group 1, 18 patients) or injection of tissue adhesive (group 2, 18 patients). Episodes of recurrent bleeding were managed after the randomization procedure. After bleeding had been controlled, patients in both groups received weekly sessions of conventional sclerotherapy to eradicate any remaining esophageal veins. The patients in the two treatment groups had similar characteristics on entry into the study. More than 80% of the patients were admitted with moderate or severe hemorrhage. Approximately half of them presented with active bleeding during the index endoscopy. Early recurrent bleeding was observed in ten of the 18 patients in group 1 (55.6%) and in two of the 18 in group 2 (11.1%; P = 0.01). The hospital mortality rates were 72.2% in group I and 33.3% in group II (P = 0.04). These findings support the view that cyanoacrylate injection is superior to conventional sclerosis for controlling esophageal variceal bleeding in Child-Pugh class C patients. It is also highly probable that the better bleeding control achieved using the cyanoacrylate tissue adhesive treatment led to a lower hospital mortality rate.

4705 Endoscopic treatment of gastric angiodysplasia with elastic band ligation. short and long-term results in 22 patients.

The aim of the present study was to evaluate the short and long-term efficacy of elastic band ligation (EBL) to treat gastric angiodysplasia (GA). Methods. 22 patients (p.) (17 male, mean age 73 ± 6 yrs., range 63-89 yrs.) with upper gastrointestinal bleeding (UGB) (17 p.) or anemia (5 p.) diagnosed of GA were included. EBL was performed with single or multipleband ligating devices. UGB episodes and the need for transfusion were assessed during follow-up. Results. 9 p. (41%) had multiple GA lesions and 4 p. (18%) showed an actively bleeding GA on endoscopy. 16 p. underwent one session of EBL (ligation of 1 GA lesion in 14 p., 2 lesions in 1 p., and 3 lesions in 1 p.). During a mean follow-up of 20 ± 10 months, none of these p. experienced UGB or received transfusions for UGB, although one p. with a multiple myeloma received blood transfusion. Six p. needed more than 1 session of EBL due to further UGB episodes or anemia, with a mean interval between sessions of 6 months (3 days-19 months). These p. were followed for a mean of 23 ± 11 months (see Table). In four p. with multiple lesions only the largest lesion or the actively bleeding lesion were treated. No complications related to EBL were identified. Conclusion. Elastic band ligation is an effective and safe procedure to treat gastric angiodysplasia.

Endoscopic hemorrhoidal ligation: preliminary clinical experience

Background: Endoscopic hemorrhoidal ligation may provide an alternative to surgical treatment of internal hemorrhoids. This study assessed the safety and efficacy of endoscopic elastic band ligation for bleeding internal hemorrhoids. Methods: Endoscopic hemorrhoid ligation was performed in 20 adult patients who had chronic rectal bleeding attributed to internal hemorrhoids. Elastic band ligation was accomplished using a ligating device attached to the end of a video endoscope. Repeat endoscopy was done 3 weeks after the initial procedure. Results: Seventy band ligations were performed during 23 separate sessions. Post-therapy endoscopy showed reduction of hemorrhoidal size by at least one grade in 19 of 20 patients (95%). Bleeding resolved in 19 of 20 patients (95%) in 5.4 months (mean) of follow-up; 18 of 20 (90%) required only one banding session. No major complications (perforation, secondary bleeding, deep ulceration) occurred in this small group. Conclusions: Preliminary data indicates that endoscopic hemorrhoidal ligation is a safe and effective technique for treating internal hemorrhoids. It holds promise as an important technique for successfully treating and possibly eradicating symptomatic internal hemorrhoids. (Gastrointest Endosc 1998;48:49-52.)

Elastic band ligation: An alternative treatment for gastric angiodysplasia

Elastic band ligation: An alternative treatment for gastric angiodysplasia

Prospective study of bacteremia rate after elastic band ligation and sclerotherapy of esophageal varices in patients with hepatosplenic schistosomiasis

Background: Esophageal band ligation is considered to be as efficient as endoscopic sclerotherapy, with a lower complication rate, including bacteremia. There are few studies comparing the two methods. The aim of this study was to compare the incidence of bacteremia after both treatments in patients with portal hypertension secondary to schistosomiasis. Methods: Endoscopic sclerotherapy and band ligation were performed using standard techniques. Blood samples were obtained 5 and 30 minutes after endoscopic band ligation or sclerotherapy and cultured for aerobic and anaerobic organisms. Results: In the sclerotherapy group 2 of 43 (4.6%) blood cultures were positive ( Peptostreptococcus sp and Streptococcus mitis). A similar result was obtained in the band ligation group: 2 of 35 (5.7%) had positive cultures, both with Staphylococcus aureus. Conclusions: There is no difference in the frequency of bacteremia after treatment of esophageal varices with endoscopic sclerotherapy or endoscopic band ligation in patients with portal hypertension secondary to schistosomiasis.(Gastrointest Endosc 1997;46:321-3)

Endoscopic treatment of gastric angiodysplasia with elastic band ligation

Gastric angiodysplasia (GA) is often diagnosed as a cause of acute or chronic upper gastrointestinal bleeding (UGB) and may be responsible for up to 2% to 6% of these cases. 1 Bown SG Swain CP Storeyow et al. Endoscopic laser treatment of vascular anomalies of the upper gastrointestinal tract. Gut. 1985; 26: 1338-1348 Crossref PubMed Scopus (73) Google Scholar , 2 Quintero E PiquÉ JM Bordas JM et al. Hemorragia digestiva alta por malform aciones vasculares gastroduodenales. Gastroenterol Hepatol. 1984; 7: 301-311 Google Scholar , 3 Smith JW Jensen DM. Gastrointestinal angiomas. Source of recurrent bleeding. Postgrad Med J. 1987; 82: 171-182 Google Scholar Moreover, GA may be particularly difficult to treat and is usually associated with a high rebleeding rate. 4 Cello JP Grendell JH. Endoscopic laser treatment for gastrointestinal vascular ectasias. Ann Intern Med. 1986; 104: 352-354 Crossref PubMed Scopus (70) Google Scholar

Endoscopic treatment of gastric angiodysplasia with elastic band ligation

Gastric angiodysplasia (GA) is often diagnosed as a cause of acute or chronic upper gastrointestinal bleeding (UGB) and may be responsible for up to 2% to 6% of these cases. 1 Bown SG Swain CP Storeyow et al. Endoscopic laser treatment of vascular anomalies of the upper gastrointestinal tract. Gut. 1985; 26: 1338-1348 Crossref PubMed Scopus (73) Google Scholar , 2 Quintero E PiquÉ JM Bordas JM et al. Hemorragia digestiva alta por malform aciones vasculares gastroduodenales. Gastroenterol Hepatol. 1984; 7: 301-311 Google Scholar , 3 Smith JW Jensen DM. Gastrointestinal angiomas. Source of recurrent bleeding. Postgrad Med J. 1987; 82: 171-182 Google Scholar Moreover, GA may be particularly difficult to treat and is usually associated with a high rebleeding rate. 4 Cello JP Grendell JH. Endoscopic laser treatment for gastrointestinal vascular ectasias. Ann Intern Med. 1986; 104: 352-354 Crossref PubMed Scopus (69) Google Scholar

Single-operator hemorrhoid ligator.

A new device for elastic band ligation of hemorrhoids is presented. The three instruments used for this procedure, the anoscope, clamp, and ligator, are combined to allow performance of the procedure by a single operator.