Band ligation for colonic bleeding: modification of multiband ligating devices for use with a colonoscope

Background: Current multiband ligating devices can be useful in the treatment of colorectal hemorrhage but are not designed to be used with a colonoscope. This restricts the ability to treat more proximal sites of colonic bleeding with this type of device. This study describes methods of modifying multiband ligating devices for use with a colonoscope, and the application of both single band and modified multiband ligating devices in the treatment of colonic bleeding. Methods: Five consecutive patients with colorectal hemorrhage were treated endoscopically with a single-band ligating device or a modified multiband ligating device. The lesions treated included two post-polypectomy ulcers, one arteriovenous malformation, one post-coagulation ulcer after ablation of an arteriovenous malformation, and one diverticulum. Results: Colonoscopic band ligation using either device was successful in all five patients with follow-up ranging from 2 to 5 months. Conclusions: Colonoscopic band ligation appears to be a safe and effective treatment for various types of colorectal hemorrhage. Currently available multiband ligating devices can be easily modified for use with a colonoscope. Endoscopic band ligation of colonic bleeding may be particularly useful in patients with coagulopathies and those cases in which bleeding is uncontrollable with other therapeutic modalities.