A new device for endoscopic band ligation for colorectal diverticular bleeding

Abstract

Background and study aims Endoscopic band ligation (EBL) has been reported to be effective for colorectal diverticular bleeding. However, current EBL devices have some limitations, and we have developed a novel EBL device.

Methods This novel EBL device has a tapered hood attached to the tip of the endoscope and an outer cylinder that loads two EBL bands. Twelve EBL procedures were performed in a live porcine model alternately using a conventional EBL device (Group C) and the novel EBL device (Group N).

Results EBL was successful in all cases in both groups. There were no cases of perforation in the 10 days after EBL. After ligation, the mean major axis of the ridge was significantly larger in Group N than Group C (9.7 ± 1.4 mm vs 7.2 ± 1.4 mm, P = 0.011). Pathological examination revealed disruption of the muscularis propria at four of the six ligation sites in Group C and at five of the six ligation sites in Group N.

Conclusions Using this novel EBL device, it was possible to perform multiple ligation procedures in succession with a good field of view. No perforation was observed, but disruption of the muscularis propria was observed at approximately three-quarters of the ligation sites pathologically.

Publikationsverlauf

Eingereicht: 21. April 2022

Angenommen nach Revision: 07. September 2022

Accepted Manuscript online:
14. September 2022

Artikel online veröffentlicht:
15. November 2022

• References

• 1 Kaise M, Nagata N, Ishii N. et al. Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding. Dig Endosc 2020; 32: 240-250
• 2 Nagata N, Ishii N, Manabe N. et al. Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association. Digestion 2019; 99: 1-26
• 3 Schultz JK, Azhar N, Binda GA. et al. European Society of Coloproctology: guidelines for the management of diverticular disease of the colon. Colorectal Dis 2020; 22: 5-28
• 4 Ishii N, Setoyama T, Deshpande GA. et al. Endoscopic band ligation for colonic diverticular hemorrhage. Gastrointest Endosc 2012; 75: 382-387
• 5 Nagata N, Niikura R, Sakurai T. et al. Safety and effectiveness of early colonoscopy in management of acute lower gastrointestinal bleeding on the basis of propensity score matching analysis. Clin Gastroenterol Hepatol 2016; 14: 558-564
• 6 Hayasaka J, Kikuchi D, Odagiri H. et al. Effectiveness of clipping for definitive colonic diverticular bleeding in preventing early recurrent bleeding. Intern Med 2022; 61: 451-460
• 7 Ishii N, Hirata N, Omata F. et al. Location in the ascending colon is a predictor of refractory colonic diverticular hemorrhage after endoscopic clipping. Gastrointest Endosc 2012; 76: 1175-1181
• 8 Kawanishi K, Kato J, Kakimoto T. et al. Risk of colonic diverticular rebleeding according to endoscopic appearance. Endosc Int Open 2018; 6: E36-E42
• 9 Ikeya T, Ishii N, Nakano K. et al. Risk factors for early rebleeding after endoscopic band ligation for colonic diverticular hemorrhage. Endosc Int Open 2015; 3: E523-E528
• 10 Akutsu D, Narasaka T, Wakayama M. et al. Endoscopic detachable snare ligation: a new treatment method for colonic diverticular hemorrhage. Endoscopy 2015; 47: 1039-1042
• 11 Kawano K, Kawano R, Moriguchi T. et al. Over-the-scope clipping and detachable snare ligation as a novel combination hemostatic therapy for diverticular bleeding. Endoscopy 2022; 54: 218-219
• 12 Fujimoto A, Sato S, Kurakata S. et al. Effectiveness of high-dose barium enema filling for colonic diverticular bleeding. Colorectal Dis 2011; 13: 896-898
• 13 Nagata N, Niikura R, Ishii N. et al. Cumulative evidence for reducing recurrence of colonic diverticular bleeding using endoscopic clipping versus band ligation: systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36: 1738-1743
• 14 Sato Y, Yasuda H, Fukuoka A. et al. Delayed perforation after endoscopic band ligation for colonic diverticular hemorrhage. Clin J Gastroenterol 2020; 13: 6-10
• 15 Shiratori Y, Ikeya T, Suzuki K. et al. Comparison of endoscopic band ligation devices used for colonic diverticular bleeding: in vivo animal study. JGH Open 2020; 5: 50-55