Rubber Band Research Articles

Challenge in prominent grade IV hemorrhoid management: a case report

Background: Management of grades 1 and 2 of internal hemorrhoids is non-operative by advising the patients to have a high-fiber diet and take phlebotropic agents such as MPFF (Micronised Purified Flavonoid Fraction). Rubber band ligation is the alternative in case of failure office-like procedure sclerotherapy. Management of grade 3 and 4 internal hemorrhoids is operative management. The gold standard of hemorrhoid surgery is the Morgan Milligan method, an excisional surgery, since this method results in a low recurrence rate. Case presentation: We presented a twenty-six-year-old male patient who came to St Elizabeth Hospital, Semarang, with a chief complaint painful lump in the anal canal for the past 7 days. For about 3 years, he got chronic spontaneously reducible anal pile and bleed, and since 2 months, the pile has enlarged and only can be reduced manually. Since 7 days ago, nonreducible anal lump (prolapse). He was several times treated medically by General Practitioner. The patient was in good condition on physical examination but looked painful with VAS: 7. The anal region looked like a big prolapsing anal canal skin and mucosa with a dentate line in between. The lump looked hyperemic, with edema and some thrombus. Conclusion: Management of big grade IV internal hemorrhoids is challenging. Combination Morgan Milligan for a big pile and HAL-RAR for the rest of the pile gives a good result. The administration of MPPF one gram three times daily, pre and post-operatively, reduce the edema, post-operative pain and risk of bleeding, which is clinically significant.

Hemorrhoid laser dearterialization: systematic review and meta-analysis.

Hemorrhoidal disease is a common and troublesome condition. Excisional hemorrhoidectomy can assure the best chance of cure but it is hampered by postoperative pain and potential long-term morbidity therefore minimally invasive techniques have been developed. Since 2009 a doppler-guided hemorrhoidal dearterialization with laser (the hemorrhoidal laser procedure; HeLP) has been proposed to control symptoms without significant sequelae. The aim of this systematic review is to analyze the benefits and disadvantages of HeLP for symptomatic hemorrhoids. The Medline/PubMed, Embase, and Cochrane library databases were searched from January 2010 to March 2022, language was restricted to English and documents to the full text. Randomized and non-randomized, prospective and retrospective cohort studies were included. Risk of bias assessment was performed using the Risk of bias for non-randomized studies (ROBINS-I) and the RoB2 Tool for randomized clinical trial. Primary outcome was to assess the efficacy of HeLP on symptoms' resolution. Secondary objectives were postoperative pain and complications, comparison with other interventional techniques, and evaluation of long-term recurrence. Whenever possible, a meta-analysis was conducted. The GRADE approach was employed to assess the certainty of evidence. We included six non-randomized and one randomized study. HeLP improved or resolved preoperative symptoms in 83.6 to 100% of patients during follow-up. In the randomized study symptoms resolved in 90% of patients after HeLP and 53.3% after rubber band ligation as comparator. Published data indicate that HeLP is effective, relatively safe, with limited recurrence rate, after a short to medium follow-up. The quality of evidence was however low. There is a paucity of studies assessing the benefits or harms of laser dearterialization for the treatment of hemorrhoids and randomized trials are furthermore rare, therefore trials with adequate power and proper design, assessing the advantages and disadvantages of HeLP versus other minimally invasive techniques, are needed. Furthermore, studies evaluating long-term follow-up are wanted.

Minimally Invasive Treatment for Advanced Hemorrhoids.

Hemorrhoids, the most common anorectal disease, give rise to symptoms such as bleeding, prolapse, and pruritus. The treatment for advanced hemorrhoids (Grade III or IV) is gradually shifting toward minimally invasive procedures. These procedures focus on reduction of blood flow in hemorrhoids. Conventional hemorrhoidectomy (CH), also known as Milligan-Morgan or Ferguson hemorrhoidectomy, is considered as the standard treatment for Grade III and IV hemorrhoids because it achieves the lowest recurrence rate. Over the years, alternative minimally invasive techniques such as stapled hemorrhoidopexy and transanal hemorrhoidal dearterialization (THD) have been developed. A new, effective sclerosant, aluminum potassium sulfate and tannic acid (ALTA), has been developed in Japan and has been used for all grades of hemorrhoids; however, its effectiveness declines over time. Other minimally invasive, nonsurgical procedures, including rubber band ligation, endoscopic injection sclerotherapy, and infrared coagulation, have also been performed for Grade III hemorrhoids. Those minimally invasive treatments improve bleeding and prolapse and are highly recommended for patients who are unfit for CH. THD with mucopexy or ALTA sclerotherapy has also been performed for Grade IV hemorrhoids. However, the recurrence rate after ALTA sclerotherapy for Grade IV hemorrhoids was higher than that for Grade III lesions in our case study. In conclusion, minimally invasive treatments are a valid alternative for patients with advanced hemorrhoids after clear explanation of recurrence rates and possible complications.

Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review.

Hemorrhoidal disease (HD) is considered a low-severity pathology by both general population and physicians, but the lengthy conservative therapy and postoperative complications suggest otherwise. To assess the effectiveness of different treatment options, both conservative and surgical, in contrast with some preexisting comorbidities. We conducted a retrospective, 10-yearlong study between January 2011 and December 2021 in two surgical centers, a private and a state-owned hospital. We compared the efficacy and safety of several treatment options, such as open hemorrhoidectomy, stapled hemorrhoidopexy, rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease (IBD), use of anticoagulant medication (AM) and liver cirrhosis. We also conducted a 20-years long PubMed research (1.263 articles) for relevant comparisons. Our study recorded 10940 patients with HD, 10241 with conservative and 699 with surgical treatment. Out of these, the male-to-female ratio of 1.3, and a peak in age distribution between 59 and 68 years old (32% of patients). For the entire study, we recorded a 90% incidence of immediate pain, immediate bleeding in 1.5% (11 cases), delayed bleeding in 1.0% (7 cases), and 0.6% surgical site infections. Urinary retention was also present, with 0.2% of patients, anal stricture in 1% and fecal incontinence for 0.5% of patients (4 cases). We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations. IBD accounted for 6% of the patients, with ulcerative colitis in 12% and Chron`s disease in 10.5%. 6.6% of the patients had AM, determining 4% immediate and 2% delayed bleeding, in surgically treated patients. Our study determined that most common complications (pain, urinary retention, bleeding, and stricture) are correlated with each surgical technique and pre-existing comorbidities.

Macroscopic analogue to entangled polymers.

The entangled structure of polymeric materials is often described as resembling a bowl of spaghetti, swarms of earthworms, or snakes. These analogies not only illustrate the concept, but form the foundation of polymer physics. However, the similarity between these macroscopic, athermal systems and polymers in terms of topology remains uncertain. To better understand this relationship, we conducted an experiment using X-ray tomography to study the structure of arrays of linear rubber bands. We found that, similar to linear polymers, the average number of entanglements increases linearly with the length of the ribbons. Additionally, we observed that entanglements are less frequent near the surface of the container, where there are also more ends, similar to what has been seen in trapped polymers. These findings provide the first experimental evidence supporting the visualization of polymer structures using macroscopic, athermal analogues, confirming the initial intuitive insights of the pioneers of polymer physics.

Rubber Band Syndrome: A Rare Orthopaedic Condition in South Africa

Abstract Religious or traditional bands are often placed around limbs of children. This practice may lead to the Rubber Band Syndrome, a rare paediatric condition mainly described in Asia. This study presents the first case of Rubber Band Syndrome reported in South Africa. The patient aged 18 months presented with a swollen right hand, a circumferential scar on the wrist and a discharging sinus. Under general anaesthesia, debridement revealed a yellow rubber band deep to the wrist flexors and neurovascular bundles. This was removed without repair of these structures. At 3-month follow up, function of the right hand was completely restored.

Prevalence and Disinfection of Bacteria Associated with Various Types of Wristbands

The potential role of personal items in the transmission of pathogens is poorly understood. In this study, we cultured bacteria of public health importance found on wristbands, determined whether there is a correlation between wristband material and prevalence, and tested three household disinfectants for efficacy in reducing bacteria on wristbands made of plastic, rubber, metal, and cloth, using standard microbiological assays. Total cultivable bacteria, Staphylococci, Enterobacteria (Escherichia coli), and Pseudomonas on 20 smartwatch wristbands were cultured from randomly recruited subjects. Nearly all wristbands (95%) were contaminated, with the highest average numbers of 3.46E+4 cfu/cm2 and 1.52E+4 cfu/cm2 on rubber and plastic bands respectively. Metallic gold and silver wristbands had zero to 18 cfu/cm2. While the high prevalence of Staphylococcus spp (85% of wristbands)—skin microbiota; was not unexpected, the occurrence of Pseudomonas spp (30%), and enteric bacteria (60%), even at relatively low numbers is of public health significance. Bacterial load on individual subjects varied remarkably with males and females harboring average total bacteria of 4.045 and 3.42 log10cfu/cm2 of wristband, respectively. The most important predictor of wristband bacteria load was the texture of wristband material and activity (hygiene) of the subject at sampling time. Potential pathogens—Staphylococcus aureus (8143 cfu/cm2) and Pseudomonas spp. (1126 cfu/cm2) were most abundant on cloth and rubber wristbands, respectively, while the presence of the E. coli group was associated with animal handling activity by a veterinarian. Lysol Disinfectant Spray and 70% Ethanol were highly effective regardless of wristband material with >99.99% kill rate and a log cfu/cm2 reduction of 3 - 4.0 and 3 - 4.5 respectively within 30 seconds. Apple Cider Vinegar (ACV) was not as potent. Only 2 - 3.5 log cfu/cm2 drop was obtained after 120 seconds of exposure. Further susceptibility assays with standard reference bacteria showed that Lysol and 70% alcohol effectively killed > 99.99% (>8 log CFU drop) of Escherichia coli strain 7001, Staphylococcus aureus strain 6538, and Pseudomonas aeruginosa strain 10662 within 30 seconds of contact. Vinegar had a similar efficacy on the gram negatives but little or no effect on Staph aureus (only a 2-log CFU/ml reduction in 5 minutes!) The high prevalence of potential pathogens, some of which could be reservoirs of antibiotic resistance reveals a weak link in infection control and underscores the need for regular cleaning of personal and hand-held accessories with adequate considerations of their texture.

Analysis of the Force Characteristics of Seoi-nage based on the Performance Height of Elite Male Judo Athletes

Seoi-nage is a representative technique frequently used in judo. Therefore, it is essential to identify how seoi-nage force characteristics change under various conditions. This study aimed to determine the differences in the force characteristics at different performance heights of elite male judo athletes. Twenty elite male judo athletes participated in the study. They were asked to perform seoi-nage at different heights (80 cm and 60 cm) using a rubber band as a practice situation. Data were collected by a force-measurement device with a rubber band connected to the device. The time variables, force value magnitude, force value rate, and force value angle in the vertical/horizontal planes were calculated and compared at 80 cm and 60 cm. There were significant differences in the force magnitude and the force vector vertical angle at 80 cm and 60 cm (p<.05). The force magnitude was greater at 60 cm than at 80 cm height. The force vector vertical angle was greater at 60 cm than at 80 cm height. In conclusion, seoi-nage at 80 cm height requires less force than at 60 cm; hence, judo players should perform the seoi-nage throw placing their center of mass lower than that of an opponent. Practicing seoi-nage repeatedly at 60 cm height under the training conditions is recommended. Seoi-nage at 60 cm height can be considered an effective training method for increasing the ability to handle difficult opponents.

The Dhaga Syndrome: An Important Differential of Acquired Constriction Band around the Wrist in India

Rubber band syndrome aka Dhaga syndrome is a rare entity mostly seen in young population in communities where rubber bands/mauli dhaga are worn over the wrist for decorative or religious purposes. If the band is worn for long duration, then it produces constrictive features burrowing through the skin and subcutaneous tissue.

HEMORRHOIDECTOMY VERSES RUBBER BAND LIGATION

According to some estimates, haemorrhoids afflict up to one-quarter of all individuals. There are numerous methods available to manage them, ranging from topical and medicinal medicines to outpatient treatments and surgical techniques to repair or excise. Given the disease's polysymptomaticism, determining which therapy choice is optimal is tough. Hemorrhoid disease treatment is one of the most difficult fields in general surgery, with various approaches utilised to cure this illness. In this research, we contrasted Hemorrhoidectomy verses Rubber Band Ligation results of treatment methods for hemorrhoids. Review the effectiveness and safety of the two most often used conventional treatments for haemorrhoids, rubber band ligation and excisional haemorrhoidectomy, and compare between the clinical results for both procedures. The PubMed database and EBSCO Information Services were utilized to choose the articles. In this review, all pertinent articles related to both our topic and other articles were used. Other articles that have nothing to do with this subject were not included. The group members looked through a certain format in which the data had been extracted. Internal hemorrhoid is a common pathological anorectal appearance, although it is a difficult condition to treat. Internal haemorrhoids symptoms and indicators should be thoroughly explored, as should clinical grading. Individual thinking and clinical considerations should influence the various possibilities for managing internal haemorrhoids and specific therapeutic approaches. At first, lifestyle changes should be made, such as consuming a high-fiber diet, developing sane bathroom routines, and administering phlebotropic drugs. When alternative treatments don't work, surgical methods and outpatient procedures should be used. Therapy management such as Hemorrhoidectomy or Rubber Band Ligation is critical to preventing future consequences from internal haemorrhoids.

Analysis of Pyrolytic Product Distribution for B3 and Non-B3 Medical Waste Pyrolysis

<p class="E-JOURNALAbstractBodyEnglish">The coronavirus disease (COVID-19) has badly impacted many sectors, particularly medical waste generation in healthcare facilities. The increasing amount of medical waste poses a serious threat to health and environmental sustainability. Traditional waste processing (burning) cannot be used for B3 medical waste and is often mixed with non-B3 medical waste. This is because it potentially generates dangerous chemicals emitted into the atmosphere. Meanwhile, pyrolysis as a superior thermochemical technology is an effective solution for treating both B3 medical waste and non-B3 medical waste. The waste used in this study has good characteristics, as indicated by the low water and high fixed carbon content. The pyrolysis process yields products with economic value, such as solid, liquid, and gas products. Therefore, this study aims to determine the levels of products that can be produced from B3 and non-B3 medical waste. The results showed that rubber bands produce the highest proportion of liquid products at 44%, the highest solid products were obtained from LDPE plastic waste with a proportion of 65%, while the highest gas product was produced by mask waste at 45%. Based on the results, waste with high product yields can be used as an alternative energy source, such as gasoline, LPG, briquettes, and battery-based materials.</p>

Wrapping Objects with an Automatic Contraction Ring

The rubber band gripper is an automatic contraction ring that is used to wrap and fix objects of various shapes by vacuuming the inside of the ring. It can be used to handle objects as a robot gripper, as well as fix bodies to pedestals, and objects to bodies. This study geometrically analyzes object shapes that can be wrapped using the ring, without causing gaps in the gripping mechanism. The analysis and experimental results show that the object shapes that can be wrapped without gaps are determined by the maximum shrinkage rate after the ring contacts the object as well as the circumference of the object. The range of object shapes that can be wrapped without gaps narrows as the object position moves away from the center of the ring. However, this influence is small, except when the object is small or has a large aspect ratio. In particular, when the object shape is cylindrical, it can be wrapped without gaps regardless of its position within the ring.

Usefulness of the combined orthodontic rubber band and clip method for gastric endoscopic submucosal dissection

Background and aimsEffective traction is an important prerequisite for successful endoscopic submucosal dissection (ESD). The combined orthodontic rubber band (ORB) and clip method was effective in colorectal cancer ESD. To date, the method was not reported in gastric ESD. This study aimed to investigate its efficacy and safety for gastric neoplasms ESD.MethodsWe retrospectively analyzed data of 118 patients with gastric neoplasms treated by ESD from November 2020 to April 2022, 43 by ORB-ESD and 75 by the conventional ESD. The primary outcome measure was the ESD procedure time. Clinical data on efficacy and safety were also collected and analyzed. Propensity score matching (PSM) matched the patients in both groups.ResultsPSM successfully matched 31 pairs of patients. The ORB-ESD operation time was shorter (median [interquartile range], 35 [30–48] vs. 49 [40–70] min, P < 0.001) and dissection speed was higher (median [interquartile range], 22.6 [14.4–29.3] vs. 13.5 [9.6–17.9] mm2/min, P < 0.001) than in the conventional ESD. The groups were similar in muscular injury rate, frequency and time of use of thermal hemostatic forceps, postoperative adverse events, en bloc resection, and R0 resection rate (P > 0.05).ConclusionsCompared to the conventional ESD, ORB-ESD significantly reduced the procedure time and increased the dissection speed, proving beneficial to gastric ESD.

Thread a needle with two hands: inner countertraction using clip with rubber band facilitates difficult pancreatic cannulation during ERCP.

Thread a needle with two hands: inner countertraction using clip with rubber band facilitates difficult pancreatic cannulation during ERCP.

Characterization of the Commercial Rubber Band as a Shape Memory Smart Material by Swelling Process with Fused Stearic Acid

This study attempted to focus the light on the characterization possibility of the vulcanized, chlorinated, natural rubber products (as the commercial rubber band used in this study) as a shape memory smart material in the case of impregnating it with fused stearic acid by swelling mechanism. Where in this study, the ability of the commercial rubber band on fixing the stretching strain chosen in this study which is of 70% after removing the applied load off the rubber band, was measured after impregnating it with stearic acid (SA) material of weight ratio (30.4%) and swelling time=2hr. At the same time, measuring the ability of that rubber band on rid of this mechanical deformation once it is thermally stimulated and returning to its original shape (before the deformation) by subjugating it to the hot classical shape memory cycle (based on normal cooling at room temperature) with its two stages represented by the shape memory effect (SME) property activation and deactivation stages. Also, the techniques of differential scanning calorimetry (DSC) and x-ray diffraction (XRD) were used to know the agreement between these tests and the SME property test results (thermomechanical cycle test). Through the practical results of all the tests depending on the diagnosis, it was shown that the direct responsibility for the characterization of the commercial rubber band as a shape memory smart material is the stearic acid (SA) material, which acted as a lock in the rubber band structure that can be opened and closed with a temperature change within the melting range of (SA).

Interventional treatment of haemorrhoids in anticoagulated patients

Anticoagulants are currently widely used for cardiological reasons, stroke prevention and in other vascular diseases. Colorectal surgeons face patients suffering from haemorrhoids who are put on anticoagulant therapy in their everyday practice. Anticoagulation strategy for patients undergoing interventional treatment of haemorrhoids has not been discussed in detail in the literature so far. Standard management of grade 1-3 haemorrhoids includes rubber band ligation (RBL), sclerotherapy (SCL) and infrared coagulation (IRC) after unsuccessful conservative treatment. The rates of postprocedural bleeding range from 0.9-2.8% after rubber band ligation, 0-2.7% after sclerotherapy and 5% after infrared coagulation. Surgical procedures including dearterialization, haemorrhoidectomy and stapled haemorrhoidopexy are indicated in more advanced degrees as the third line of treatment and are complicated by postoperative bleeding in 1.4-5.9% and 2-7.9% patients, respectively. Haemorrhoidectomy is the best option in grade 4 haemorrhoids and is associated with 6.2-8.4% risk of bleeding. However, closed haemorrhoidectomy, Ligasure technique and/or anal tamponade can reduce this risk. Surgical guidelines recommend continuing acetylsalicylic acid in low bleeding risk procedures, including haemorrhoidal surgery. However, postoperative bleeding after rubber band ligation was more common in the aspirin group. On the other hand, haemorrhage incidence after sclerotherapy did not differ significantly between the group on anticoagulation compared with the group without anticoagulation. Haemorrhoidectomy should be postponed for 6 months in patients receiving dual antiplatelet therapy. According to the guidelines, vitamin K antagonists should be discontinued 5 days before haemorrhoidal surgery. Minimal bleeding risk procedures do not require discontinuation of anticoagulation,but this option seems to be hazardous for patients undertaking rubber band ligation. Sclerotherapy, on the other hand, could not require warfarin discontinuation if the international normalized ratio (INR) is within therapeutic range. Novel oral anticoagulants (NOACs) should be discontinued 1 day before low bleeding risk operations, including haemorrhoidectomy and resumed 1 day after the procedure. In conclusion, all anticoagulants should be ceased prior to operation except for aspirin. There are not clear recommendations on the perioperative protocols for continuation or discontinuation of blood thinners in patients undergoing minimally invasive procedures.

Improving Guntingan Skills by Using Simple Training Tools

Introduction. The purpose of this study was to determine the effect of training using simple training tools, namely rubber band, ropes and foam sticks, on the Guntingan skills of Pencak Silat athletes. &#x0D; Materials and methods. This study used an experimental method with a pretest-posttest control group design. In this design there were two sample groups, namely the experimental simple training tools group and the simple guntingan skills training group. 60 athletes from Betako Merpati Putih PPS Pencak Silat School at MA Al-Khairiyah Jakarta participated in this study, devided into two groups where the experimental group included 30 students and the control group included 30 students. This study used a waist guntingan test instrument which consists of 26 aspects of assessment that were validated by 3 experts in Pencak Silat. &#x0D; Results. There are significant differences in the participants’ test results before and after they were given training using simple tools and traditional training to improve guntingan skills, but there is a difference in the effect of each of the guntingan skill trainings in the two groups. The training using simple training tools has better effect on the guntingan skills than the traditional training method.&#x0D; Conclusions. Unconventional training tools are effective to be used in Pencak Silat guntingan skills training. The improvement of athletes in performing guntingan skills shows that simple training tools can be used for Pencak Silat training. Further study could observe the effect of the tools used in this study on other Pencak Silat skills, or skills in other martial arts and sports.

Teaching Social Skills Interventions with Digital Cognitive and Language Machines to a Student with Autism

The present paper, through a case study of a student with autism, refers to the diversity in language and social skills and the communication difficulties across the lifespan.It aims to support the social skills based on the pedagogical principles of teamwork and student-centeredness according to the Framework for Analytical Special Education Program (FASEP) in secondary inclusive education. The main hypothesis examines the meaning of teaching in autism for philologists (Greek language teachers) who use -a] differentiations with targeted individual-structured "social stories" and -b] interventions in the emotional organization by verbalizing feelings with digital cognitive and language machines in a student with autism. The methodology of the inclusion intervention programs use the pedagogical tool TISIPfSEN (Targeted, Individually Structured, and Inclusive Intervention Programs for Students with Special Educational Needs). Accompanied by a questionnaire which given to (N = 104) philologists. The individually targeted social skills instructional interventions with digital cognitive and communication machines were implemented with a rubber band folder and a digital folder for a student with autism. With structured, graded-difficulty learning readiness exercises, the understanding of the meaning of language rules of cooperation with others was supported. Philologists have understood that autism difficulties following through the semantic aspect of language affect the individual’s social skills in abstract thinking and the multiple meanings of social stories' words. Finally, they confirmed the usefulness of TISIPfSEN for students with autism by teaching language interventions in social skills and the multimedia approach with a conventional and digital dossier.

Regional Differences in Procedural Care of Hemorrhoid Management in Medicare Patients; Unwarranted Variation in Clinical Practice for a Medical-First Problem

IntroductionHemorrhoid disease is very common problem in the Medicare population. Prior work has shown significant variation in county-level practices of hemorrhoidectomy; however, regional variation of rubber band ligation (RBL) has yet to be assessed. This is important as many different practitioners from different specialties can perform this procedure repeatedly in an office-based setting. We aim to evaluate the variation of RBL and hemorrhoidectomy over a 7-y period. MethodsUsing Medicare part B claims data, we identified all beneficiaries >65 y seen for hemorrhoid disease between 2006 and 2013. Current Procedural Terminology (CPT) codes were used to identify all events for hemorrhoidectomy (46083, 46250, 46255, 46257, 46260, and 46261) or RBL (46221) by hospital referral region (HRR). We determined HRR-level rates of hemorrhoidectomy and RBL per 1000 beneficiaries adjusted for age, sex, and race. We calculated annual coefficients of variation (SD × 100/mean) for hemorrhoidectomy and RBL. Results1.2 to 1.3 million fee-for-service Medicare beneficiaries were seen annually for evaluation of hemorrhoid disease. Mean-adjusted annual rates for hemorrhoidectomy by HRRs varied from 4.34 to 63.03 per 1000 beneficiaries. Mean-adjusted rates of RBL by HRRs varied from 7.06 to 163 per 1000 beneficiaries. Annual procedural coefficients of variation over the study period were 41-48 (high) for hemorrhoidectomy and 69-74 (very high) for RBL. ConclusionsWhile continued high variation exists for hemorrhoidectomy, there is very high variation for RBL between HRRs in treating hemorrhoid disease among Medicare beneficiaries. There are substantial Medicare expenditures in this high-volume population that are likely unwarranted.

Comparison of efficiency and safety between dual-clip and rubber band-assisted ESD and conventional ESD for colonic lateral spreading tumors (LSTs) with different levels of technical difficulty: a retrospective case–control study

BackgroundDual-clip and rubber band-assisted endoscopic submucosal dissection (DCRB-ESD) is a useful technique in the management of lateral spreading tumors (LSTs) of the colon and is suggested by researchers compared with conventional ESD (C-ESD). The aim of this retrospective study is to further analyze the efficiency and safety of DCRB-ESD in a setting with varying technical difficulties.MethodsPatients who underwent endoscopic treatment (DCRB-ESD or C-ESD) due to LSTs between Jan 1st, 2019 and Jan 1st, 2022, were retrospectively collected. Patients were classified into the following two groups: the DCRB-ESD group (n = 46) and the C-ESD group (n = 81). Baselines were compared and propensity score matching (PSM) was employed to manage the heterogeneity. The technical difficulty and outcomes of the two groups were evaluated based on a semiquantitative model (CS-CRESD) previously described.ResultsThe baseline characteristics of the two groups were balanced except sex and LST classification before PSM and were corrected after PSM. The median ESD operation time of DCRB-ESD was shorter than that of C-ESD (32 vs 41 and 30 vs 44 before and after PSM respectively, P < 0.05). The operation durations of cases with different CS-CRESD scores were different (P < 0.05). In the subgroup with a score of 0, DCRB-ESD showed no advantage than C-ESD in terms of operation duration before and after PSM. In subgroups with a score of 1–3, DCRB-ESD was faster than C-ESD. In subgroups with a score of 4–5, the between-group operation duration was not significantly different due to the limited number of cases, although the median time of DCRB-ESD was shorter. The R0 resection rates, curative resection, complications, and additional surgery in both groups were not significantly different. No adverse events, such as a clip falling off or rubber band rupturing occurred during this study.ConclusionDCRB-ESD was an efficient and safe procedure in the management of colonic LSTs. With DCRB-ESD, the operation duration of difficult cases can be shortened without sacrificing complication risk. However, not all cases would benefit from DCRB-ESD. For easy cases (CS-CRESD score = 0), DCRB-ESD may not be prior to C-ESD by experienced endoscopists. A pre-ESD technical difficulty evaluation was recommended to decide whether to perform DCRB-ESD or not.