Original Contribution
The American Journal of Gastroenterology (2007) 102, 1372–1376; doi:10.1111/j.1572-0241.2007.01211.x
The Effects of the Number of Rubber Bands Placed at Each Endoscopic Session Upon Variceal Outcomes: A Prospective, Randomized Study
CME
Francisco C Ramirez MD, Victor J Colon MD, Derek Landan MD, Andrew J Grade MD and Elizabeth Evanich NP
Departments of Medicine and Research, Gastroenterology Section, Carl T. Hayden Veterans Affairs Medical Center, Phoenix, Arizona
Correspondence: Francisco C Ramirez, MD, Chief, Gastroenterology, Carl T. Hayden VA Medical Center, 650 E Indian School Rd., Phoenix, AZ 85012.
Received 22 September 2006; Accepted 5 February 2007.
Abstract
AIM:
To determine the role of the number of bands placed per session upon patient-related and procedural-related outcomes.
METHODS:
Patients were assigned to receive as many bands as could be possibly placed (group 1) or up to a maximum of six bands (group 2) per session. The primary outcome measured was the number of sessions to achieve obliteration. Other outcomes measured included: rebleeding, variceal recurrence, mortality (within 6 wk and within 1 yr), complications, banding and total procedure times, and number of bands misfired.
RESULTS:
A total of 86 patients were enrolled: 45 in group 1 and 41 in group 2. The two groups had similar age, Child-Pugh scores, grade of varices at entry. The overall proportion of patients achieving obliteration was 56% (53% and 59% for groups 1 and 2, respectively). Despite receiving significantly more mean bands per session, patients in group 1 required similar (mean 
SEM) number of sessions to obliteration (2.9 0.3 vs 3.3 0.3) and total number of bands (20.0 2.4 vs 16.6 1.8) to achieve this goal compared with group 2. The overall proportion of patients with variceal rebleeding was 25%, the 1-yr variceal recurrence 31.3%, and the overall early- and 1-yr mortality were 18.6% and 33.7%, respectively. These proportions were similar in the two groups. Banding and total procedure times were significantly longer and associated with significantly more misfired bands per session in group 1.
CONCLUSION:
Compared with a maximum of six bands per session, the placement of >6 bands per session was not associated with better patient outcomes but with significantly more prolonged banding and total procedure times and significantly more misfired bands.
