Endoscopic Rubber Band Ligation Research Articles

Endoscopic polidocanol foam sclerobanding for the treatment of grade II-III internal hemorrhoids: A prospective, multi-center, randomized study.

Endoscopic rubber band ligation (ERBL) is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain. To evaluate satisfaction, long-term recurrence, and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL. This was a prospective, multicenter, randomized study. A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding (EFSB) or an ERBL group. All patients were followed-up for 12 months. Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score (HSS) and a visual analog scale (VAS). Continuous variables were reported as medians and interquartile range. One hundred and ninety-five patients were enrolled, with 98 in the EFSB group. HSS was lower in the EFSB group than in the ERBL group at 8 weeks [4.0 (3.0-5.0) vs 5.0 (4.0-6.0), P = 0.003] and 12-month [2.0 (1.0-3.0) vs 3.0 (2.0-3.0), P < 0.001] of follow-up. The prolapse recurrence rate was lower in the EFSB group at 12 months (11.2% vs 21.6%, P = 0.038). Multiple linear regression analysis demonstrated that EFSB treatment [B = -0.915, 95% confidence interval (CI): -1.301 to -0.530, P = 0.001] and rubber band number (B = 0.843, 95%CI: 0.595-1.092, P < 0.001) were negatively and independently associated with the VAS score 24 hours post-procedure. The median VAS was lower in the EFSB group than in the ERBL [2.0 (1.0-3.0) vs 3.0 (2.0-4.0), P < 0.001]. Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.

Evaluation of a novel disposable endoscope for retroflexed endoscopic rubber band ligation of internal hemorrhoids: a randomized pilot study.

Retroflexed endoscopic rubber band ligation (ERBL) for treating Grade II and III internal hemorrhoids using disposable endoscopes has not been previously assessed. We therefore compared the safety and effectiveness of ERBL for internal hemorrhoids using novel disposable endoscopes versus traditional reusable endoscopes. This prospective randomized controlled trial involved 42 patients who underwent ERBL for Grade II and III internal hemorrhoids using either a disposable endoscope (n= 21) or a reusable endoscope (n= 21). Safety was assessed by the incidence of equipment failure, device-related adverse events, and in-procedure stability of vital signs. Effectiveness was assessed by the postoperative therapeutic effect, feasibility of retroflexed ERBL, and incidence of complications. In terms of safety, no life-threatening events, equipment failure, or device-related adverse effects occurred during the procedures in either group. The rate of diastolic blood pressure stability was significantly different between the two groups (P= .049), but the rates of systolic blood pressure and heart rate stability were similar. In terms of effectiveness, the therapeutic effects on postoperative Day 30 were similar in both groups. Image clarity and endoscopic flexibility in the disposable endoscope group were mildly inferior to those in the reusable endoscope group, but without statistical significance. Matching between the endoscope and ligating device was 100% in both groups. The incidence of complications on postoperative Days 1 and 10 was not significantly different between the two groups. Compared with reusable endoscopes, disposable endoscopes are equally safe, feasible, and reliable in ERBL for internal hemorrhoids.

Comparison of the long-term efficacy and safety of multiple endoscopic rubber band ligations in a single session for varying grades of internal hemorrhoids.

There is no consensus onthe number of ligation bandsforvarying grades of internal hemorrhoids (IH) in a single sessionof endoscopic rubber band ligation (ERBL). The aims of this study were to investigate this issue. Patients withIHwere treated with ERBL. The primary endpointwas no hemorrhoid symptoms 6weeks after ERBL.The secondary endpointswerepostoperative complications and recurrence. One hundred twenty-three eligible patients met the inclusion criteria, and 3 patients were excluded. The average bands were 3.9 ± 1.1, and grade II hemorrhoids required significantly fewer bands than grade III hemorrhoids (3.45 ± 0.85 vs 4.35 ± 1.06, P = 0.000). 78.8%of patients achieved the primary endpoint. The efficacy of grade II hemorrhoids was higher than that of grade III hemorrhoids (87.8% vs 69.2%). The incidence of postoperative complications was not significantly correlated with the grade of hemorrhoids (P = 0.201) and the number of bands (P = 0.886). The median follow-up time was 14.3 ± 7.9 (1.3-30.9) months. The overall recurrence rate was 25.0%, with grade III significantly higher than grade I-II (32.8% vs 14.6%, P = 0.027). For grade III hemorrhoids, the recurrence rate was lower with more than 4 bands of ligation than with less than 4 bands (26.5% vs 53.3%). The average ERBL treatment of IH requires nearly four bands, and grade II hemorrhoids require less banding than grade III hemorrhoids, while the efficacy was better. Increasing the number of bands improves the treatment efficacy for grade III IH, which could be a strategy to reduce the recurrence rate without increasing postoperative complications.

Hypertrophic Anal Papillotomy by Transparent Cap-Assisted Endoscopic Hot Snare Resection

Background/Aim: Conventional treatment for hypertrophic anal papillae (HAP) has effectiveness and safety concerns. This study aimed to investigate the feasibility, safety, and efficacy of transparent cap-assisted endoscopic hot snare resection for the treatment of HAP. Methods: Endoscopic and clinical data of patients treated with transparent cap-assisted endoscopic hot snare resection for HAP at the Department of Gastroenterology, First Affiliated Hospital of Yangtze University from June 2019 to June 2021, were collected and retrospectively analyzed. Results: A total of 56 patients with HAP were treated with transparent cap-assisted endoscopic hot snare resection, including 53 patients (94.6%) with single hypertrophic anal papillae and 3 patients (5.4%) with multiple HAP; 51 patients (83.6%) with basal diameter <5 mm and 10 patients (16.4%) with basal diameter ≥5 mm. The procedures that were performed together with transparent cap-assisted endoscopic hot snare resection for HAP treatment included total colon examination in 56 cases (100%), endoscopic polypectomy in 20 cases (35.7%), endoscopic sclerotherapy for hemorrhoids in 29 cases (51.8%), and endoscopic rubber band ligation for hemorrhoids in 11 cases (19.6%). No patient experienced bleeding during or after HAP with transparent cap-assisted endoscopic hot snare resection. Pain level was evaluated by the visual analog score (VAS) method. 52 patients (92.9%) did not have pain and 4 patients (7.1%) had mild pain 3 days after surgery. At a postoperative follow-up of 2 to 18 months, patient satisfaction with transparent cap-assisted endoscopic hot snare resection for HAP treatment was 100% (56/56). Conclusion: Transparent cap-assisted endoscopic hot snare resection is safe and effective for treating HAP.

ENDOSCOPIC BAND LIGATION FOR THE TREATMENT OF HEMORRHOIDAL DISEASE

There are several therapeutic options for symptomatic hemorrhoids, from hygienic and dietary measures to conventional surgery. The best technique adopted for alternative and non-surgical treatment for intermediate grade (II and III) hemorrhoidal disease is rubber band ligation. More recently, the technique has been used with the aid of a gastroscope and a kit of elastic rubber bands for esophageal varices. This technique was called Endoscopic Rubber Band Ligation of hemorrhoids (ERBL). The objective is Compare the results and the incidence of the immediate and late complications in patients undergoing ERBL. The satisfaction with the treatment of patients undergoing different number of rubber band ligatures were also analyzed. This is a cohort study included patients undergoing ERBL from 2007 to 2014 at the hospital. The incidence of early and late complications and the satisfaction with the treatment of patients undergoing until two ligatures and patients undergoing three or more ligatures in the same procedure were compared. The study included 116 patients. The most frequently reported symptom was anal bleeding (n=72; 62.1%). The number of rubber band ligatures performed during the ERBL procedure varied from one to six; 84 (72,4%) patients had three or more rubber band ligatures performed during the procedure. No significant associations were observed between the incidence of early or late complications and satisfaction with ERBL among the group subjected until two rubber band ligatures or three or more rubber band ligatures. The endoscopic elastic ligation method proved to be a feasible, safe and efficient for the treatment of symptomatic hemorrhoidal disease grades II and III. The technique had moderate rates of immediate and late complications, but most of the complications are considered of low magnitude, easily resolved and without clinical repercussions, no matter how much ligations were performed in the same procedure.

Endoscopic Rubber Band Ligation of Internal Hemorrhoids: Turning Hemorrhoidal Management from Surgery into an Office-Based Gastroenterology Endoscopic Practice

Hemorrhoids are laxed prolapsed anorectal fibrovasular cushions that cause symptoms when they prolapse excessively specially when they are traumatized by hard faeces causing bleeding They are very common affecting up to of the population especially elderly Hemmorrhoids needs management when they become symptomatic especially when they bleed Endoscopic rubber band ligation is increasing being recommended as the fist and best effective office based out patient treatment for symptomatic hemorrhoids since other office based treatment options and surgical approaches are more expensive painful amp associated with more complications

A prospective randomised comparative study of endoscopic band ligation versus injection sclerotherapy of bleeding internal haemorrhoids in patients with liver cirrhosis

Background and study aimsBleeding internal haemorrhoids are common and used to be treated surgically with too many complications. Endoscopic therapy is trying to take the lead. Sclerotherapy and rubber band ligation are the candidates to replace surgical therapy especially in patients with liver cirrhosis. The aim of this study was to compare endoscopic injection sclerotherapy (EIS) to endoscopic rubber band ligation (EBL) regarding effectiveness and complications in the treatment of bleeding internal haemorrhoids in Egyptian patients with liver cirrhosis. Patients and methodsOne hundred and twenty adult patients with liver cirrhosis and bleeding internal haemorrhoids were randomised into two equal groups; the first treated with EBL using Saeed multiband ligator, and the second with EIS using either ethanolamine oleate 5% or N-butyl cyanoacrylate. All groups were matched as regards age, sex, Child score and pre-procedure Doppler values. Patients were followed up clinically and with abdominal ultrasound/Doppler for 6months. Endoscopic and endosonography/Doppler was done before and one month after the procedure. Pre and post-procedure data were recorded and analysed. ResultsBoth techniques were highly effective in the control of bleeding from internal haemorrhoids with a low rebleeding [10% in the EBL group and 13.33% in the EIS group] and recurrence [20% in the EBL group 20% in the EIS group] rates. Child score had a positive correlation with rebleeding and recurrence in EIS group only.Pain score and need for analgesia were significantly higher while patient satisfaction was significantly lower in EIS compared to EBL [p<0.05]. No significant difference between ethanolamine and cyanoacrylate subgroups was found [p>0.05]. ConclusionsBoth EBL and EIS were effective in the treatment of bleeding internal haemorrhoids in patients with liver cirrhosis. EBL had significantly less pain and higher patient satisfaction than EIS. EBL was also safer in patients with advanced cirrhosis.

EVALUATION OF ENDOSCOPIC HEMORRHOIDAL LIGATION IN 119 PATIENTS

Background: Rubber-band ligation of internal hemorrhoids is a well-established office procedure. In addition, endoscopic rubber-band ligation of esophageal varices has become widely accepted. Combining and modifying these techniques, we have conducted endoscopic hemorrhoidal ligation (EHL) since 1993, and we feel that it is appropriate now to evaluate the procedure. Methods: One hundred and nineteen patients who were subjected to EHL were followed and evaluated. Results: Endoscopic hemorrhoidal ligation was markedly effective in 67 cases (56.3%), effective in 41 cases (34.5%), and ineffective in 11 cases (9.2%). Out of the 11 ineffective cases, three of them received surgical hemorrhoidectomy and eight were treated by conservative measures with frequent or continuous use of suppositories. The most common complications after EHL were postoperative anal pain and slight bleeding. Out of 92 patients followed long-term, the 5-year non-recurrence rate was 90.4%. Persistent therapeutic effects were observed in 62 patients (67.4%), whereas 22 patients (23.9%) had to be treated by suppositories and/or ointments as necessary, and eight patients (8.7%) had a relapse. Out of the eight relapsed cases, four received repeated EHL with symptomatic remission, two received hemorrhoidectomy, and two were treated conservatively. Conclusion: Endoscopic hemorrhoidal ligation is an effective method for treating internal hemorrhoids. However, indications for this treatment should be properly decided in each patient, using their history, and general and local conditions.

Carvedilol in the treatment of portal hypertension.

Variceal bleeding is a major event in the natural history of end-stage liver disease with a subsequent high mortality rate. Non-selective β-blockers are currently the drugs of choice for preventing first variceal bleeding. Endoscopic rubber band ligation of high risk varices features as a first line option if cirrhotic patients cannot tolerate β-blockers. Despite adequate β-blockade, some patients may still present with variceal bleeding. The effect of carvedilol, a non-selective β and α-1 receptor-blocker, on lowering portal pressure has been investigated in several clinical trials and found to be superior to propranolol in both acute and chronic hemodynamic studies. Recently, carvedilol has also been compared with band ligation for primary prophylaxis against variceal bleeding with equivalent results to band ligation. Patient tolerance to carvedilol in advanced liver disease remains a source of concern. This review examines the place of carvedilol as an alternative to the currently recommended pharmacological therapy in prophylaxis against variceal bleeding.

Endoscopic Rubber Band Ligation of Internal Hemorrhoids in a Community GI Practice: A Patient Validated Survey of Clinical Efficacy

Purpose: Endoscopic treatment of internal hemorrhoids is directed at relieving symptoms of rectal bleeding. In this study its efficacy in a community GI practice was judged by a survey of patients' symptoms after treatment. Methods: 137 patients who underwent endoscopic rubber band ligation of bleeding internal hemorrhoids at United Hospital System between 2/1/05 to 2/1/10 were sent a symptom survey in March of 2010. The patients were asked the following questions. 1) Satisfaction with the treatment on a scale of 0 to 10. 2) Current presence of rectal bleeding and its magnitude if still present. 3) Endorsement of this treatment for someone with rectal bleeding from internal hemorrhoids. Results: 53 patients filled out and returned the survey. There were 30 males and 23 females. The mean age was 60 years. The mean time from the last treatment to the survey was 33.4 months. The mean no. of rubber band ligation sessions per patient was 1.3 with 42 patients undergoing only one session. The number of patients with none or minimal bleeding was 43. The number of patients endorsing this treatment was 43. The mean satisfaction score for all patients was 7.4. This jumped to 8.8 in patients with none or minimal bleeding. Conclusion: Endoscopic Rubber Band Ligation of bleeding internal hemorrhoids was highly effective in a majority of patients after one session only with a high satisfaction score.

Endoscopic Hemorrhoid Ligation Is Simple, Safe, and Effective

To the Editor: We read with interest the paper by Jutabha et al. (1) in the August 2009 issue of the American Journal of Gastroenterology, which compared endoscopic rubber band ligation (RBL) and bipolar coagulation for chronically bleeding internal hemorrhoid. The authors concluded that the success rate was significantly higher with RBL than with bipolar coagulation, but the cases of severe pain during treatment were also more.

Randomized Prospective Study of Endoscopic Rubber Band Ligation Compared With Bipolar Coagulation for Chronically Bleeding Internal Hemorrhoids

Randomized Prospective Study of Endoscopic Rubber Band Ligation Compared With Bipolar Coagulation for Chronically Bleeding Internal Hemorrhoids

Randomized Prospective Study of Endoscopic Rubber Band Ligation Compared With Bipolar Coagulation for Chronically Bleeding Internal Hemorrhoids

Our purpose was to compare the efficacy, complications, success rate, recurrence rate at 1 year, and crossovers of rubber band ligation (RBL) with those of bipolar electrocoagulation (BPEC) treatment for chronically bleeding internal hemorrhoids. A total of 45 patients of mean age 51.5 years, who had rectal bleeding from grade II or III hemorrhoids and in whom intensive medical therapy failed, were randomized in a prospective study comparing RBL with BPEC. Treatment failure was predefined as continued bleeding, occurrence of a major complication, or failure to reduce the size of all internal hemorrhoidal segments to grade I in < or =3 treatments. Patients were followed up for 1 year. With similar patients, rectal bleeding and other symptoms were controlled with significantly fewer treatments of RBL than of BPEC (2.3+/-0.2 vs. 3.8+/-0.4, P<0.05), and RBL had a significantly higher success rate (92% vs. 62%, P<0.05). RBL had more cases of severe pain during treatment (8% vs. 0%, P<0.05), but significantly fewer failures and crossovers (8% vs. 38%). Symptomatic recurrence at 1 year was 10% RBL and 15% BPEC. For patients with chronically bleeding grade II or III internal hemorrhoids that are unresponsive to medical therapy, safety and complication rates of banding and BPEC were similar. The success rate was significantly higher with RBL than with BPEC. Symptom recurrence rates at 1 year were similar.

3638 Randomized, prospective trial of endoscopic rubber band ligation compared to bipolar coagulation for bleeding internal hemorrhoids

Internal hemorrhoids are the most common cause of recurrent hematochezia (BRB) in ambulatory adults.We compared the efficacy and safety of bipolar coagulation (BICAP) with endoscopic rubber band ligation (RBL) for hemostasis of bleeding internal hemorrhoids (IH). Methods: This was a randomized prospective trial of patients with IH bleeding, documented by anoscopy and colonoscopy, who continued to have BRB inspite of at least 60 days of medical therapy (bulk agents, suppositories, stool softeners). Exclusions were rectal fissures, AIDS, inflammatory disease, or incidental IH and another source of bleeding found. After grading of IH with a slotted anoscope, patients were randomized to anoscopic treatment with BICAP (16W, 1 secs pulses) or RBL (via videoendoscope) and treatments were applied above the dentate line on 3 IH segments/session. Endpoints were control of BRB, severe complication or refusal to continue the treatment, and reduction of all IH segments to grade ≤ 1 in ≥ 3 treatment sessions. Failures were crossed over to other therapies. Results: 37 patients with mean age of 51 and chronic IH symptoms for ≤ 9 yrs were treated, 18 with BICAP and 19 with RBL. See table for results. Significantly fewer treatment sessions with RBL were required for control of BRB. Conclusions: For patients with chronic internal hemorrhoids and recurrent hematochezia unresponsive to medical therapy: 1) bipolar coagulation and rubber band ligation were similar in efficacy and safety for hemostasis, 2) non-significantly more bipolar than RBL patients had treatment failures and were crossed-over to other treatments, and 3) RBL required significantly fewer sessions to control hematochezia and reduce the size of internal hemorrhoids than bipolar coagulation. Funded in part by NIH DK41301 (Human Studies Core), American Digestive Health Foundation Endoscopy Research Award, and NIH-GCRC M01-RR008658.

Endoscopic variceal ligation is superior to combined ligation and sclerotherapy for esophageal varices: A multicenter prospective randomized trial

Patients who have bled from varices remain at risk for rebleeding. There is interest in methods that would enable rapid eradication of varices. The present trial was designed to study whether combining ligation with sclerotherapy will allow quicker eradication of varices than either modality alone. Patients with bleeding esophageal varices were randomized into ligation or combination therapy groups. Patients in the ligation group were treated with endoscopic rubber band ligation alone. In combination group patients, each variceal column was ligated distally and 1 mL of ethanolamine was injected proximal to each ligated site. Subsequent treatment sessions were at 7- to 14-day intervals until varices were eradicated. The clinical and endoscopic characteristics of 25 patients in the ligation group were similar to those of 22 patients in the combination group. Follow-up was up to 30 months. Active bleeding was controlled in 100% of patients in the ligation group and 75% of those in combination group (P = NS). It took 3.3 +/- .4 (range, 1-7) sessions to eradicate varices with ligation and 4.1 +/- .6 (1-7) with combination therapy (P = NS). Survival (four deaths in ligation group, 8 in combination group), rebleeding rate (25% vs. 36%), and varix recurrence (16% vs. 23%) also were similar. There were more complications with combination therapy, including deep ulcers (65% vs. 20%; P < .05); dysphagia (30% vs. 0%; P < .05), with three strictures requiring dilation; and pain (30% vs. 10%; P = NS). Our results show that sclerotherapy combined with ligation offers no benefit over ligation alone. The higher complication rate with combination therapy does not warrant this approach.(Hepatology 1997 Jan;25(1):71-4)

Fatigue properties of brazed aluminium alloy joints: Sato, S., Sukimoto, M., Itonaga, S. and Honda, T. J. Jpn Inst. Light Met. (Sept. 1993) 43 (9), 478–483 (in Japanese)

Bleeding internal haemorrhoids are common and used to be treated surgically with too many complications. Endoscopic therapy is trying to take the lead. Sclerotherapy and rubber band ligation are the candidates to replace surgical therapy especially in patients with liver cirrhosis. The aim of this study was to compare endoscopic injection sclerotherapy (EIS) to endoscopic rubber band ligation (EBL) regarding effectiveness and complications in the treatment of bleeding internal haemorrhoids in Egyptian patients with liver cirrhosis.One hundred and twenty adult patients with liver cirrhosis and bleeding internal haemorrhoids were randomised into two equal groups; the first treated with EBL using Saeed multiband ligator, and the second with EIS using either ethanolamine oleate 5% or N-butyl cyanoacrylate. All groups were matched as regards age, sex, Child score and pre-procedure Doppler values. Patients were followed up clinically and with abdominal ultrasound/Doppler for 6 months. Endoscopic and endosonography/Doppler was done before and one month after the procedure. Pre and post-procedure data were recorded and analysed.Both techniques were highly effective in the control of bleeding from internal haemorrhoids with a low rebleeding [10% in the EBL group and 13.33% in the EIS group] and recurrence [20% in the EBL group 20% in the EIS group] rates. Child score had a positive correlation with rebleeding and recurrence in EIS group only.Pain score and need for analgesia were significantly higher while patient satisfaction was significantly lower in EIS compared to EBL [p < 0.05]. No significant difference between ethanolamine and cyanoacrylate subgroups was found [p > 0.05].Both EBL and EIS were effective in the treatment of bleeding internal haemorrhoids in patients with liver cirrhosis. EBL had significantly less pain and higher patient satisfaction than EIS. EBL was also safer in patients with advanced cirrhosis.