Background: Endoscopic band ligation for bleeding small-bowel vascular lesions has been reported its safe and efficacious based on small case series. There have been several other published case reports of band ligators, used for bleeding lesions, usually Dieulafoy's lesions, in the stomach, the proximal small bowel, and the colon, In addition, this method has been used for postpolypectomy bleeding stalks, Then, has never been a critical look at the anatomic consequences of banding in the thinner sections of bowel. Method: The purpose of this study is to define the anatomic and histologic consequences of applying band ligator devices to the small and the large bowel. Fresh surgical specimens, both large and small bowel, that were excised because of neoplastic lesions were transported to our endoscopic unit where one end intact bowel was sutured shut. A standard upper endoscope was passed via the open ends and the bowel was closed lightly With rubber band ties. The bowel then was insufflated. and band ligators were applied to unaffected mucosa by using a standard technique. Photodocumentation from inside and outside the bowel was obtained. Some of the band polyps were cut above the band, and some were cut below the band if) the fresh state. Some were fixed ill formalin and examined microscopically. Histologic sectioning occured at the level of the bands. Results: The results were striking in that there were large holes (1 cm) in the fresh ileum specimen. There was gross serosal entrapment manifested by visible puckers on the outer surfaces of the specimens, especially in the small bowel and the right colon. The left colon, anatomically thicker, was affected, The histologic evaluation revealed inclusion by the band ligator of the muscularis propria and serosa on the small bowel, the musclaris propria in the right colon, and the submucosa in the left colon. Conclusions: Based on these findings, we conclude that blind ligator devices are not safe in the small bowel anti the right colon but probably are safe in the thicker left colon.
