Cost saving by reloading the multiband ligator in endoscopic esophageal variceal ligation: A proposal for developing countries

Using disruptive innovation to design endoscopic ligators for resource-challenged health settings

BACKGROUND

Commercial single-use endoscopic multiband ligators, used for esophageal variceal band ligation (EVL), are prohibitively expensive. To enable greater access to EVL, we used disruptive innovation to develop a novel endoscopic multiband ligator.

METHODS

We designed and tested a prototype handle 'ENDOhandle' using computer-aided design modeling and exported a cap, trigger cord and latex to form a functional banding unit.

RESULTS

The cost of the banding unit was US$4.80 compared with several hundred US dollars for commercially available devices in the USA.

CONCLUSIONS

Disruptive innovation technology developed an inexpensive ligator for resource-challenged health settings.

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.