Endoscopic band ligation for bleeding small-bowel vascular lesions has been reported as safe and efficacious based on small case series.
There have been several other published case reports of band ligators used for bleeding lesions.
These reports were on patients with Dieulafoy's lesions, in the stomach, the proximal small bowel, and the colon.
This method has also been used for postpolypectomy bleeding stalks.
There has not yet been a critical look at the anatomic consequences of banding in the thinner sections of bowel.
Dr Barker and colleagues from Texas defined the anatomic and histologic consequences of applying band ligator devices to the bowel.
Fresh surgical specimens, both large and small bowel, that were excised because of neoplastic lesions were transported to the team's endoscopy unit.
| Large holes of 1 cm were found in the fresh ileum specimen|
At the team's unit, an end of the intact bowel was sutured shut.
The researches passed a standard upper endoscope via the open end, and the bowel was closed tightly with rubber band ties.
The bowel then was insufflated, and the team applied band ligators to unaffected mucosa by using a standard technique.
The researchers obtained photodocumentation from inside and outside the bowel.
The team reported that some of the band polyps were cut above the band, and some were cut below the band in the fresh state.
In addition, the team fixed some of the band polyps in formalin and examined them microscopically, while histologic sectioning occurred at band level.
The researchers found large holes of 1 cm in the fresh ileum specimen.
The team also observed gross serosal entrapment manifested by visible puckers on the outer surfaces of the specimens.
The serosal entrapment was especially obvious in the small bowel and the right colon.
However, the team noted that the left colon, which is anatomically thicker, was less affected.
The histologic evaluation revealed inclusion by the band ligator of the muscularis propria and serosa on the small bowel.
The inclusion was also observed in the muscularis propria in the right colon, and the submucosa in the left colon.
Dr Barker's team concludes, “Based on these findings, we conclude that band ligator devices are not safe in the small bowel and the right colon but probably are safe in the thicker left colon.”