Clinical Indications

  • Variceal Therapy: Used for both prophylaxis (prevention of bleeding) and treatment of active esophageal variceal bleeding [00:26 Opens in a new window ].

  • Mucosal Resection: Used in Barrett’s esophagus with high-grade dysplasia to band and resect abnormal tissue [00:42 Opens in a new window ].

Equipment Components & Setup

  • Package Components: Includes a control handle, loading catheter, band ligator cap pre-loaded with bands and attached to a trip wire, and an irrigation adapter [01:17 Opens in a new window ].

  • Control Handle Positions:

    • Two-Way Position: Allows the knob to move clockwise and counter-clockwise. Used during setup to allow slack and prevent premature deployment [02:21 Opens in a new window ].

    • Firing Position: Allows rotation in the clockwise direction only to deploy bands [02:56 Opens in a new window ].

Step-by-Step Installation Procedure

  1. Prepare Channel & Catheter: Puncture the channel seal using the irrigation adapter and insert the loading catheter until it exits the distal end of the scope [03:27 Opens in a new window ].

  2. Retrieve Trigger Cord: Attach the trigger cord to the loading catheter, pull the catheter back out through the channel, and secure the cord knot into the control handle's groove [03:50 Opens in a new window ].

  3. Attach Cap & Align: Push the band ligator cap flush onto the distal tip of the endoscope. Adjust/rotate the cap so the trigger cord aligns cleanly with the biopsy channel to maintain an unobstructed view [04:28 Opens in a new window ].

Safety & Clinical Deployment

  • Pre-Insertion Safety Check: Always hand the endoscope to the physician with the handle set to the Two-Way Position [05:02 Opens in a new window ]. Keeping it in the firing position during insertion risks accidental band deployment into the pharynx or upper esophagus [05:30 Opens in a new window ].

  • Banding Strategy:

    • Perforating veins enter near the gastroesophageal (GE) junction; begin banding at or just above the GE junction and work upward sequentially [06:34 Opens in a new window ].

    • Target high-risk stigmata first (e.g., large varices, cherry-red spots, or red whale signs) [07:09 Opens in a new window ].

  • Deployment: Once at the target site, switch the handle to the Firing Position, suction the varix into the cap until the view is obscured, and rotate the knob clockwise to release a band [06:01 Opens in a new window ]. Typically up to six bands are applied per session [07:44 Opens in a new window ].