Retrospective Study
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World J Gastrointest Endosc. Oct 16, 2014; 6(10): 488-492
Published online Oct 16, 2014. doi: 10.4253/wjge.v6.i10.488
Endoscopic band ligation for bleeding lesions in the small bowel
Takashi Ikeya, Naoki Ishii, Yuto Shimamura, Kaoru Nakano, Mai Ego, Kenji Nakamura, Koichi Takagi, Katsuyuki Fukuda, Yoshiyuki Fujita
Takashi Ikeya, Naoki Ishii, Yuto Shimamura, Kaoru Nakano, Mai Ego, Kenji Nakamura, Koichi Takagi, Katsuyuki Fukuda, Yoshiyuki Fujita, Department of Gastroenterology, St. Luke’s International Hospital, Tokyo 104-8560, Japan
Author contributions: Ikeya T and Ishii N conceived of and designed the study; Shimamura Y, Ego M and Nakano K analyzed the data; Ikeya T, Ishii N, Shimamura Y, Nakamura K, Takagi K and Fukuda K performed the therapeutic endoscopy; Ikeya T and Ishii N edited the manuscript; Ikeya T and Ishii N drafted the manuscript; and Fujita Y revised the manuscript.
Correspondence to: Takashi Ikeya, MD, Department of Gastroenterology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan. takashiikeya@live.jp
Telephone: +81-3-35415151 Fax: +81-3-35440649
Received: April 23, 2014
Revised: July 7, 2014
Accepted: September 4, 2014
Published online: October 16, 2014
Abstract

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.

Keywords: 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.