Use of the Endoscopic Clipping Over the Scope Technique to Treat Acute Severe Lower Gastrointestinal Bleeding in the Colon and Anal Transition Zone

Kaltenbach, Tonya; Asokkumar, Ravishankar; Kolb, Jennifer M.; Malvar, Carmel; Soetikno, Roy

doi:10.1016/j.giec.2019.09.001

Cited by 8 publications

(3 citation statements)

References 31 publications

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“…Recently, several new and novel endoscopic haemostatic modalities have shown promising results in patients with LGIB. Small retrospective studies have reported high initial haemostasis and low rebleeding risk with use of OTSC in diverticular bleeding; this technique has also been successfully used in bleeding post-polypectomy or from an anastomotic ulcer, as well as in anal transitional zone bleeding 62,63 (Figure 6). Topical haemostatic agents have also yielded promising results in LGIB of different aetiologies including malignant, diverticular and PPB.…”

Section: New Haemostatic Toolsmentioning

confidence: 99%

“…89 Factors that are predictive of active bleeding at include left-sided polyp removal, use of electrocautery, use of anticoagulants and peduncled polyp morphology. 87 Any of the available endoscopic haemostatic modalities discussed previously can be used, including cap-mounted clips 62 or topical haemostatic agents, 90,91 although contact thermal therapy should be used with caution to decrease the risk of perforation in this setting if thermal energy was used for the polypectomy. For patients who remain haemodynamically unstable or fail endoscopic therapy, urgent interventional radiology and/or surgical evaluation is warranted.…”

Section: Treatmentmentioning

confidence: 99%

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Review article: Advances in the management of lower gastrointestinal bleeding

Alali,

Almadi,

Barkun

2023

Aliment Pharmacol Ther

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SummaryBackgroundLower gastrointestinal bleeding (LGIB) is a common emergency with substantial associated morbidity and mortality. Elective colonoscopy plays an essential role in management, with an even more important role for radiology in the acute setting. Recent advances in the management of patients with LGIB warrant review as the management has recently evolved.AimsTo provide a comprehensive and updated overview of advances in the approach to patients with LGIBMethodsWe performed a comprehensive literature search to examine the current data for this narrative review supplemented by expert opinion.ResultsThe incidence of LGIB is increasing worldwide, partly related to an ageing population and the increasing use of antithrombotics. Diverticulosis continues to be the most common aetiology of LGIB. Pre‐endoscopic risk stratification tools, especially the Oakland score, can aid appropriate patient triage. Adequate resuscitation continues to form the basis of management, while appropriate management of antithrombotics is crucial to balance the risk of worsening bleeding against increased cardiovascular risk. Radiological imaging plays an essential role in the diagnosis and treatment of acute LGIB, especially among unstable patients. Colonoscopy remains the gold‐standard test for the elective management of stable patients.ConclusionsThe management of LGIB has evolved significantly in recent years, with a shift towards radiological interventions for unstable patients while reserving elective colonoscopy for stable patients. A multidisciplinary approach is essential to optimise the outcomes of patients with LGIB.

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Section: New Haemostatic Toolsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Review article: Advances in the management of lower gastrointestinal bleeding

Alali,

Almadi,

Barkun

2023

Aliment Pharmacol Ther

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“…Although conventional hemorrhoidectomy is known as minor surgical trauma, it is associated with varying degrees of postoperative pain, and the patient heals the open wound after hemorrhoidectomy. Haemorrhoidal artery ligation (HAL) and staple hemorrhoidectomy versus open hemorrhoidectomy, have a faster recovery and low complication rate, but a higher concern is cost effectiveness and availability issues, so these transactions are not done as often as RBL [9][10] . Rubber ligation is known to be an effective and ideal treatment for second-degree haemorrhoids.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Symptomatic Hemorrhoids by Baron’s Band Ligation

Nauman¹,

din²,

Gul³

et al. 2021

PJMHS

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Haemorrhoids are a clinical symptom of a change in the normal functional architecture of the inflamed and swollen veins known as the anal cushion. Numerous treatment opportunities are available for this communal issue, but Baron's Gum Ligation (RBL) is the utmost frequently used technique for second- and third-degree haemorrhoids because it treats hemorrhoidal disease without anaesthesia, hospitalization, minimal complications, and ooutpatient discharge is uneventful compared to conventional surgery. Purpose: We conducted this study to evaluate the effectiveness of rubber band ligation in the treatment of second- and third-degree haemorrhoids. Methodology: This prospective study was performed on 76 patients over a six-month period at the Department of General Surgery from January 2021 to June 2021 at Islam Medical College and Teaching Hospital Sialkot. Rubber rubber ligation was used in all patients. A maximum of two haemorrhoids in one session were banded, and third as needed in a check-up done two weeks later. At the end of the fourth week, post-banding assessments were made for the presence and absence of bleeding, pain, and haemorrhoidal prolapse. Results: Of the 76 patients, 60 (78.9%) were male and 16 (21.1%) were female. The M:F ratio was 5.0: 1.0. 37.85 years was the mean age of patients (range 15 to 68). The duration of symptoms in approximately 48 patients (63.2%) was less than one year old, and in 18 (23.7%) patients ranged from 1 to 3 years and 10 (13.2%) patients had symptoms for more than 4 years. Complications occurred in 23 patients, bleeding in three patients, pain in 18 patients, 2 patients have prolapsed. Conclusion: RBL is effective, safe and simple method of symptomatic treatment for 2nd and 3rd degree haemorrhoids in an outpatient setting.

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