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Let’s talk tips and tricks of band ligation and OTSCs, which both utilize cap and suction.
#GITwitter @JacquelineChuMD @BilalMohammadMD @PerelmansPearls @ScopingSundays @helpatologist @UzmaSiddiquiMD @ZSobaniMD @EQuirurgica @Bjorn_Rembacken @tberzin @EarlCampbellMD
#GITwitter @JacquelineChuMD @BilalMohammadMD @PerelmansPearls @ScopingSundays @helpatologist @UzmaSiddiquiMD @ZSobaniMD @EQuirurgica @Bjorn_Rembacken @tberzin @EarlCampbellMD
Tip #1 After you suction, gently wiggle back or allow scope to straighten in lumen. This maximizes tissue suction and releases muscularis propria.
Many are taught to suction, push and wiggle. This is wrong.
Many are taught to suction, push and wiggle. This is wrong.
Tip #2: Band ligation & OTSC use a cap, which can provide temporary tamponade of active bleeding. This minimizes red out & need for suction. If bleeding varix, first get into stomach, then slowly move up, tamponading varix as you approach it on withdrawal.
Clear cap tamponade:
Clear cap tamponade:
Tip #3:
If not en fos, position the target off center, favoring the “pivot point” where the cap contacts the mucosa. The opposite side is where tissue will slide into the cap.
This is similar to “leading” a target which will arrive in the center of the cap when suctioned.
If not en fos, position the target off center, favoring the “pivot point” where the cap contacts the mucosa. The opposite side is where tissue will slide into the cap.
This is similar to “leading” a target which will arrive in the center of the cap when suctioned.
Tip #4:
OTSC must be en fos. Suction a few times before deploying to ensure “lips are puckered.” If it won’t pucker, don’t deploy.
The grasping devices limit suction and require 5 hands (twin grasper). I find them too cumbersome and traumatic if tissue failure.
OTSC must be en fos. Suction a few times before deploying to ensure “lips are puckered.” If it won’t pucker, don’t deploy.
The grasping devices limit suction and require 5 hands (twin grasper). I find them too cumbersome and traumatic if tissue failure.
Tip #5:
Unlike a band, OTSC has directionality.
To avoid 1 of 4 “pillars” from obstructing the lumen, position the axis of the jaws in line with the axis of the lumen.
This must be deliberately planned even before installing the OTSC.
Unlike a band, OTSC has directionality.
To avoid 1 of 4 “pillars” from obstructing the lumen, position the axis of the jaws in line with the axis of the lumen.
This must be deliberately planned even before installing the OTSC.
This is even more critical with the OTSC Stentfix, which is best installed vertically 6-12 o’clock. To deploy, look up and bite half the esophageal stent and half the mucosa.
Tip #6:
Banding hemorrhoids is not like banding varices.
Do not target stigmata or the “plumpest” site but rather the base just above the hemorrhoid. You are looking for the feeder vessel and to “tack” up high the hemorrhoidal tissue with fibrosis.
Banding hemorrhoids is not like banding varices.
Do not target stigmata or the “plumpest” site but rather the base just above the hemorrhoid. You are looking for the feeder vessel and to “tack” up high the hemorrhoidal tissue with fibrosis.
Remember the cap suctions much more tissues than it’s diameter.
Targeting stigmata (low) can grasp anoderm below the dentate line and cause pain.
Targeting stigmata (low) can grasp anoderm below the dentate line and cause pain.
Tip #7:
Banding (inverting) a bleeding diverticulum is safe, effective, and durable especially in the L colon.
Mark it with a clip or tattoo (+Epi), install bander, and suction to invert and band!
https://www.jwatch.org/na44984/2017/09/07/band-ligation-shown-most-effective-therapy-colonic
Banding (inverting) a bleeding diverticulum is safe, effective, and durable especially in the L colon.
Mark it with a clip or tattoo (+Epi), install bander, and suction to invert and band!
https://www.jwatch.org/na44984/2017/09/07/band-ligation-shown-most-effective-therapy-colonic
Tip #8:
Augment suction (especially OTSC) https://twitter.com/drbloodandguts/status/1331445750023196673
Augment suction (especially OTSC) https://twitter.com/drbloodandguts/status/1331445750023196673
