Is it safe to perform endoscopic band ligation for the duodenum? A pilot study in <i>ex vivo</i> porcine models

Kakutani, Hiroshi; Sasaki, Shigemasa; Ueda, Kaoru; Takakura, Kazuki; Sumiyama, Kazuki; Imazu, Hiroo; Hino, Shoryoku; Kawamura, Muneo; Tajiri, Hisao

doi:10.3109/13645706.2012.703955

Cited by 13 publications

(10 citation statements)

References 22 publications

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“…In addition, this study demonstrated the safety of the EBL procedure. It was reported that EBL was not safe for treatment of the small bowel, as histologic evaluation revealed inclusion of the muscularis propria and serosa by the band-ligator [24,25] . There were no complications or instances of perforation or penetration in the present study, though the study was limited to only six cases.…”

Section: C B Amentioning

confidence: 99%

“…There are some reports concerning the use of EBL for treating small intestinal bleeding lesions [13,[21][22][23] , though the safety and efficacy of this use has not been established. However, a recent report indicates that EBL is unsafe and unsuitable for hemostasis in the small bowel [24,25] . Therefore, the aim of this study was to retrospectively investigate the safety and efficacy of EBL for the treatment of bleeding lesions in the small bowel.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic band ligation for bleeding lesions in the small bowel

Ikeya¹

2014

WJGE

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AIM:To investigate the safety and efficacy of endoscopic band ligation (EBL) for bleeding lesions in the small bowel.METHODS: This is a retrospective study evaluating EBL in six consecutive patients (three males, three females, 46-86 years of age) treated between May 2009 and February 2014: duodenal vascular ectasia; 1, jejunal bleeding diverticulum; 1, ileal Dieulafoy's lesion; 1 and ileal bleeding diverticula; 3. The success of the initial hemostasis was evaluated, and patients were observed for early rebleeding (within 30 d after EBL), and complications such as perforation and abscess formation. Follow-up endoscopies were performed in four patients. RESULTS:Initial hemostasis was successfully achieved with EBL in all six patients. Eversion was not sufficient in four diverticular lesions. Early rebleeding occurred three days after EBL in one ileal diverticulum, and a repeat endoscopy revealed dislodgement of the O-band and ulcer formation at the banded site. This rebleeding was managed conservatively. Late rebleeding occurred in this case (13 and 21 mo after initial EBL), and re-EBL was performed. Follow-up endoscopies revealed scar formation and the disappearance of vascular lesions at the banded site in the case with a duodenal bleeding lesion, and unresolved ileal diverticula in three cases. Surgery or transarterial embolization was not required without any complications during the median follow-up period of 45 (range, 2-83) mo. CONCLUSION:EBL is a safe and effective endoscopic treatment for hemostasis of bleeding lesions in the small bowel.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Endoscopic band ligation; Small bowel; Diverticular hemorrhage; Jejunal bleeding; Ileal bleeding; Therapeutic endoscopy; Hemostasis Core tip: There have been few reports regarding the use of endoscopic band ligation (EBL) for the treatment of bleeding lesions in the small intestine. The present study demonstrates safe and effective use of EBL to treat six patients with small bowel lesions including, duodenal vascular ectasia, ileal Dieulafoy's lesion, and jejunal and ileal bleeding diverticula. Although the bleeding was successfully managed in all patients, those with diverticular bleeding in the small bowel should be closely monitored after an initial EBL.

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Section: C B Amentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic band ligation for bleeding lesions in the small bowel

Ikeya¹

2014

WJGE

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“…Successful closure of esophageal, gastric, and colorectal perforations by using EBL has been reported in a small number of patients. [2][3][4][5][6][7][8] TTS clips are available with different functionality, closing force, ability to be rotated, and retention time. 9,10 Technical challenges remain, and exposure and comfort vary.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic band ligation for closure of GI perforations in a porcine animal model (with video)

Law

Deters

Miller

et al. 2014

Gastrointestinal Endoscopy

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“…Significant theoretical risks are also associated with EVL. In porcine models, duodenal banding demonstrated a 100% perforation rate [20] . Additionally, it is suggested that if the entire varix cannot be banded at the time of intervention, there is the risk of creating a wide defect with re-bleeding after sloughing occurs [21] .…”

Section: Discussionmentioning

confidence: 99%

“…A gastroenterologist will encounter these only rarely as they represent only about 0.4% of all variceal bleeding [1] , yet the traditionally reported mortality approaches 40% [2] , underscoring the importance of prompt and effective management. While there have been hundreds of cases reported, most describe bleeding varices secondary to cirrhosis or intrahepatic portal hypertension.…”

Section: Introductionmentioning

confidence: 99%

Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review

Steevens

Abdalla

Kothari

et al. 2015

WJGPT

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Bleeding from duodenal varices is reported to be a catastrophic and often fatal event. Most of the cases in the literature involve patients with underlying cirrhosis. However, approximately one quarter of duodenal variceal bleeds is caused by extrahepatic portal hypertension and they represent a unique population given their lack of liver dysfunction. The authors present a case where a 61-year-old male with history of remote crush injury presented with bright red blood per rectum and was found to have bleeding from massive duodenal varices. Injection sclerotherapy with ethanolamine was performed and the patient experienced a favorable outcome with near resolution of his varices on endoscopic follow-up. The authors conclude that sclerotherapy is a reasonable first line therapy and review the literature surrounding the treatment of duodenal varices secondary to extrahepatic portal hypertension.

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Is it safe to perform endoscopic band ligation for the duodenum? A pilot study in ex vivo porcine models

Abstract: Routine EBL is not recommended in the duodenum because the risk of perforation is unacceptably high.

Cited by 13 publications

References 22 publications

Endoscopic band ligation for bleeding lesions in the small bowel

Endoscopic band ligation for bleeding lesions in the small bowel

Endoscopic band ligation for closure of GI perforations in a porcine animal model (with video)

Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review

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