A serial transparent endoscopic elastic band ligator

Clinical effects of using a reloading multiband ligator with an SD-c conductor for endoscopic variceal ligation over subsequent sessions

OBJECTIVE

The aim of the study was to compare the cost-effectiveness, efficacy and safety of using a reloading multiband ligator with a neotype conductor (SD-c) with using a disposable one for endoscopic variceal ligation (EVL) over subsequent sessions.

METHODS

Patients undergoing variceal ligation over subsequent sessions were randomly subjected to EVL using a reloading multiband ligator with an SD-c (reloading group) or a disposable ligator (control group). The cost, efficacy and safety were analyzed and compared between the two groups.

RESULTS

A total of 460 patients underwent at least one session of EVL. Variceal obliteration was achieved in 124 patients (69%) in the reloading group and in 130 patients (70%) in the control group. The number of cases in which an extra band was released during deployment was three in the reloading group and two in the controls. Acute fever was seen in 38 cases after EVL in the reloading group and in 40 cases in the controls. In the reloading group, acute variceal bleeding events within the first 24h after EVL were seen in three out of 327 (0.92%) patients versus six out of 335 (1.79%) in the control group. However, there were no significant differences between the two groups (P>0.05). The cost savings were 2350 yuan/$369.89 for one session and 4277 yuan/$673.19 per patient on average.

CONCLUSION

Although there were no statistically significant differences in efficacy or safety between the two patient groups, using a reloading multiband ligator for EVL is nevertheless a cost-savings procedure.

The effects of the number of rubber bands placed at each endoscopic session upon variceal outcomes: a prospective, randomized study

AIM

To determine the role of the number of bands placed per session upon patient-related and procedural-related outcomes.

METHODS

Patients were assigned to receive as many bands as could be possibly placed (group 1) or up to a maximum of six bands (group 2) per session. The primary outcome measured was the number of sessions to achieve obliteration. Other outcomes measured included: rebleeding, variceal recurrence, mortality (within 6 wk and within 1 yr), complications, banding and total procedure times, and number of bands misfired.

RESULTS

A total of 86 patients were enrolled: 45 in group 1 and 41 in group 2. The two groups had similar age, Child-Pugh scores, grade of varices at entry. The overall proportion of patients achieving obliteration was 56% (53% and 59% for groups 1 and 2, respectively). Despite receiving significantly more mean bands per session, patients in group 1 required similar (mean +/- SEM) number of sessions to obliteration (2.9 +/- 0.3 vs 3.3 +/- 0.3) and total number of bands (20.0 +/- 2.4 vs 16.6 +/- 1.8) to achieve this goal compared with group 2. The overall proportion of patients with variceal rebleeding was 25%, the 1-yr variceal recurrence 31.3%, and the overall early- and 1-yr mortality were 18.6% and 33.7%, respectively. These proportions were similar in the two groups. Banding and total procedure times were significantly longer and associated with significantly more misfired bands per session in group 1.

CONCLUSION

Compared with a maximum of six bands per session, the placement of >6 bands per session was not associated with better patient outcomes but with significantly more prolonged banding and total procedure times and significantly more misfired bands.

Upper gastrointestinal tract bleeding

Upper GI bleeding is a serious and common emergency. Most upper GI bleeding will stop spontaneously but determining which patients will continue to bleed or rebleed is very difficult in the ED. Resuscitation and stabilization are the primary goals of the emergency physician. Hemorrhage control with pharmacotherapy or balloon tamponade may be necessary until urgent or emergent consultation with a gastroenterologist or surgeon is obtained. Early detection and treatment of H. pylori and the development of safer NSAIDs should alter the future of upper GI bleeding dramatically.