Development and application of endoloops for the treatment of bleeding esophageal varices

• Published in: Gastrointestinal endoscopy Vol. 50; no. 5; pp. 677 - 684
• Main Authors: Hepworth, Clive C., Rodney Burnham, W., Paul Swain, C.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.1999; Elsevier
• Subjects: Animals; Biological and medical sciences; Diseases of the digestive system; Dogs; Equipment Design; Esophageal and Gastric Varices - surgery; Esophagoscopes; Gastrointestinal Hemorrhage - surgery; Hemostasis, Surgical - instrumentation; Hemostasis, Surgical - methods; Hemostasis, Surgical - statistics & numerical data; Humans; Ligation - instrumentation; Ligation - methods; Ligation - statistics & numerical data; Medical sciences; Nylons; Pilot Projects; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Random Allocation; Rubber; Statistics, Nonparametric; Stomach - surgery; Suction - instrumentation; Swine; Human; Medical equipment; Portal circulation disease; Treatment efficiency; Esophageal disease; Instrumentation therapy; Cardiovascular disease; Gastrointestinal; Hemorrhage; Venous disease; Esophagus; Esophagoscopy; Vascular disease; Ligature; Digestive diseases; Intestinal disease; Complication; Gastric disease; Varix
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(99)80020-0

Background: Endoloops are detachable nylon snares. The aims of this study were to develop an endoscopic method for repeated delivery of endoloops to arrest variceal bleeding, to compare efficacy of endoloop hemostasis with injection and band ligation in experimental of endoloops in a pilot study in patients with varices. Methods: Technical modifications including ridged endcaps and alterations in angulation of endoloops were developed to speed delivery and improve efficacy. Hemostatic efficacy of endoloops was compared with sclerotherapy and band ligation in animal studies before studies in patients. Results: Modified endcap and endoloops allowed repeated applications without withdrawal of the endoscope. Right-angled endoloops ensnared more ( p<0.0001) gastric tissue and were more reliable ( p<0.05) than straight endoloops. Injection therapy and prestretched bands appeared ineffective, whereas band ligation was only effective on vessels up to 2 mm in diameter. Only endoloops achieved hemostasis on vessels of 3 to 5 mm ( p<0.05). No significant complications occurred using endoloops in animal (esophagus n=20, stomach n=20) or human (n=11) studies. Conclusions: Endcap and endoloop modifications simplified repeated application to varices. Endoloops were more effective than injection or band ligation in experimental hemostasis and appeared safe and effective in patients.