All band ligating devices use a means of capturing a lesion or mound of target tissue while a small-diameter circular band made of rubber, latex, or similar material is deployed around the base of the tissue to accomplish tight compression that leads to vascular compromise (or haemostasis) and subsequent thrombosis, necrosis, and sloughing.
Several components are common to all endoscopic band ligating devices:
- A short transparent cylindrical cap carrying stretched bands
- The cylindrical cap fits to the leading end of the endoscope
- A tripwire that runs from the cap through the accessory channel to the control handle
- A control handle with a retracting spool that is fixed to the biopsy port for attachment and firing of the trip wire; and an
- Irrigation adapter or catheter that allows irrigation of the accessory channel.
Optimal technique for ligation of oesophageal varices:
- Initial application of bands distally, followed by progressive proximal placement of a variable number of bands until all protruding varices are captured. Starting distally allows for complete visualization and avoids the potential risk of dislodging a band during advancement of the endoscope past a previously captured varix. .
- Adequate entrapment of the varix is indicated by a complete ‘red out’ of the endoscopic view.
- Suction is maintained for approximately 5 s after band deployment to ensure ligation.
- If the band is fired prematurely before the varix has been trapped into the cap, the band will probably slip off, producing a misfire.
- Endoscopic signs of a successful firing include the varix assuming a pedunculated shape with the band visible as a collar around the variceal base, and duskiness in the colour of the head of the created ‘polyp’ from a strangulated blood supply
- Banding should be repeated every 2–4 weeks until all grade II or greater varices are obliterated. On average 3–4 endoscopic sessions are required to achieve this goal.
Complications of banding include chest pain, dysphagia, post banding ulcers, post banding ulcer bleeding, and strictures.
Multiband ligators available are:
- Auto-band Ligator (Scandimed International, Glostrup, Denmark)
- Speedband Superview Super 7 Multiple Band Ligator (Boston Scientific Corp, Natick, Mass)
- Saeed Multi-band (4, 6, 10) Ligator (Cook Endoscopy, Winston-Salem, NC).
Ref
ASGE technology status evaluation report: Endoscopic banding devices
