Effectiveness of a Ligating Device for Endoscopic Surgery

A new detachable snare for hemostasis in the removal of large polyps or other elevated lesion was developed by the author (Olympus Ligating Device). It allows ligation to be performed through the channel of an endoscope using a nonconductive loop that can be detached from the ligator. At Sakura National Hospital, endoscopic ligation with this device was performed in 80 patients from May 1989 to January 1994. The purpose of the procedure was preventive hemostasis prior to the endoscopic resection of large elevated lesions in 71 patients and for control of hemorrhage in 9 patients. The elevated lesions were polyps in 69 patients and submucosal tumor in 2, being pedunculated in 36 and semipedunculated in 35. The maximum diameter of these lesions ranged from 15 to 40 mm (mean: 23 mm), being greater than 20 mm in 57 cases. The 9 patients undergoing endoscopic ligation for hemorrhage had bleeding polypectomy stumps (n = 5), bleeding polyps (n = 3), and a bleeding esophageal varix (n = 1). Endoscopic ligation achieved the complete prevention of hemorrhage following the resection of elevated lesion in 63/71 patients (88.7%) and, in combination with a HX-3L clip, allowed endoscopic resection to be performed in 70/71 patients (98.6%). In the 9 patients with bleeding lesions, complete hemostasis was achieved without complications.