Massive gastrointestinal bleeding after endoscopic rubber band ligation of internal hemorrhoids:A case report

BACKGROUND Rubber band ligation(RBL) using rigid anoscope is a commonly recommended therapy for grade Ⅰ-Ⅲ symptomatic internal hemorrhoids. Severe complications of RBL include pain, hemorrhage and sepsis. Flexible endoscopic RBL(ERBL) is now more commonly used in RBL therapy but few severe complications have been reported. Here we report on a case of massive bleeding after ERBL.CASE SUMMARY A 31-year-old female was admitted to the department of gastroenterology with a chief complaint of discontinuous hematochezia for 2 years. No previous history, accompanying diseases or drug use was reported. Physical examination and colonoscopy showed grade Ⅱ internal hemorrhoids. The patient received ERBL therapy. Five days after ligation, the patient presented with mild hematochezia. On days 7 and 9 after ligation, she presented with a large amount of rectal bleeding, dizziness and weakness. Emergency colonoscopy revealed active bleeding and an ulcer in the anal wound. The patient received two sessions of hemoclipping on days 7 and 9 to treat the bleeding. No further bleeding was reported up to day 15 and she was discharged home. Although the hemorrhoid prolapse disappeared after ERBL, she was dissatisfied with the subsequent complications.CONCLUSION ERBL therapy is an effective treatment for symptomatic internal hemorrhoids with satisfactory short and long-term recovery. Pain and anal bleeding are the most frequently reported postoperative complications. Coagulation disorders complicate the increased risk of bleeding. Although rarely reported, our case reminds us that those patients without coagulation disorders are also at risk of massive life-threatening bleeding and need strict follow-up after ligation.

Phallic rubber band application to prevent enuresis unusual cause of urethral stricture in a child:A case report

BACKGROUND Urethral stricture is the abnormal narrowing of the urethra due to spongiofibrosis.The established aetiological factors for urethral stricture abound in our environment.However,the application of a penile rubber band to prevent enuresis thereby causing this pathology is not a familiar occurrence.Patients with enuresis can suffer psycho-social challenges and trauma,especially for a child due to peer stigmatization.This has a great impact on the child's psyche and may affect even his performance at school.The aim of this paper is to highlight the psychosocial impact and management challenges of a child with enuresis(nocturnal urinary incontinence).CASE SUMMARY This is the case of a 10-year-old boy who presented with a history of nocturnal urinary incontinence since birth and lower urinary tract symptoms(LUTS)for 3 years culminating in chronic urinary retention.He maintained a normal urge to micturate and continent of urine during the daytime before the onset of LUTS.He had an antecedent longstanding history of tying a rubber band to the penile shaft mostly before going to the bed at night to prevent enuresis due to his peer stigmatization.He was acutely ill-looking,with distended suprapubic region.The phallus and scrotum were enlarged and oedematous with a circumferential proximal penile shaft scar and ventral penile shaft urethrocutaneous fistula.He was diagnosed to have complete short segment bulbopenile stricture and right ectopic ureter.He subsequent had augmented anastomotic urethroplasty and bilateral non-refluxing ureteroneocystostomy at different sitting.CONCLUSION The adherence to surgical principles of urethral stricture and enuresis management where surgically correctable in a child is associated with the resolution of enuresis and social reintegration.

Rubber band ligation of hemorrhoids: A guide for complications

Rubber band ligation is one of the most important, costeffective and commonly used treatments for internal hemorrhoids. Different technical approaches were developed mainly to improve efficacy and safety. The technique can be employed using an endoscope with forward-view or retroflexion or without an endoscope, using a suction elastic band ligator or a forceps ligator. Single or multiple ligations can be performed in a single session. Local anaesthetic after ligation can also be used to reduce the post-procedure pain. Mild bleeding, pain, vasovagal symptoms, slippage of bands, priapism, difficulty in urination, anal fissure, and chronic longitudinal ulcers are normally considered minor complications, more frequently encountered. Massive bleeding, thrombosed hemorrhoids, severe pain, urinary retention needing catheterization, pelvic sepsis and death are uncommon major complications. Mild pain after rubber band ligation is the most common complication with a high frequency in some studies. Secondary bleeding normally occurs 10 to 14 d after banding and patients taking anti-platelet and/or anti-coagulant medication have a higher risk, with some reports of massive life-threatening haemorrhage. Several infectious complications have also been reported including pelvic sepsis, Fournier's gangrene, liver abscesses, tetanus and bacterial endocarditis. To date, seven deaths due to these infectious complications were described. Early recognition and immediate treatment of complications are fundamental for a favourable prognosis.

Superhydrophobic conductive rubber band with synergistic dual conductive layer for wide-range sensitive strain sensor

Wearable electronic devices have received increasing interests because of their excellent flexibility,stretchability,and human friendliness.As the core components,flexible strain sensors integrated with wide working range,high sensitivity,and environment stability,especially in moisture or corrosive environments,remain a huge challenge.Herein,synergistic carbon nanotubes(CNTs)/reduced graphene oxide(rGO)dual conductive layer decorated elastic rubber band(RB)was successfully developed and treated with hydrophobic fumed silica(Hf-SiO_(2))for preparing superhydrophobic strain sensor.As expected,stable entangled CNTs layer and ultrasensitive microcracked rGO layer endow the sensor with extremely low detection limit(0.1%),high sensitivity(gauge factor is 685.3 at 482%strain),wide workable strain range(0–482%),fast response/recovery(200 ms/200 ms)and favorable reliability and reproducibility over 1000 cycles.Besides,the constructed Hf-SiO_(2) coating also makes the sensor exhibit excellent superhydrophobicity,self-cleaning property,and corrosion-resistance.As a proof of concept,our prepared high-performance strain sensor can realize the full-range monitoring of human motions and physiological signals even in the water environment,including pulse,vocalization,joint bending,running,and gesture recognition.Interestingly,it can also be knitted into a tactile electronic textile for spatial pressure distribution measurement.Thus,this study provides a universal technique for the preparation of high-performance strain sensors with great potential applications in the field of next-generation intelligent wearable electronics.

Investigating Microplastics and Nanoplastics Released from a Rubber Band Used for Orthodontic Treatment with Improved Raman Imaging Algorithms

Most teenagers experience orthodontic treatment,but we do not know the possible adverse effect of the released microplastics and nanoplastics that are recently categorized as emerging contaminants.Herein,we test the rubber band that has been employed to improve the biting of teeth during the orthodontic process to confirm the release of microplastics and nanoplastics.We improve the characterization of microplastics and nanoplastics by(i)Raman imaging,to extract and map the signal from the scanning spectrum matrix or the hyperspectral matrix and to enhance the signal-to-noise ratio statistically.To effectively extract the signal,(ii)chemometrics such as principal component analysis(PCA)are explored to convert the hyperspectral matrix to an image with an increased certainty.The nonsupervised PCA is intentionally corrected,via(iii)the algebra-based algorithm,to further increase the certainty to image the microplastics and nanoplastics.Once the signal is weak,(iv)an additional algorithm of image reconstruction via deconvolution is developed to average the background noise and smooth the image.By doing so,we estimate that millions of microplastics and nanoplastics are released daily in potential from a rubber band applied in a teenager's mouth,which might be a big concern.Overall,our approach provides a suitable option to characterize the microplastics and nanoplastics from a complex background.

Endoscopic polidocanol foam sclerobanding for the treatment of grade Ⅱ-Ⅲ internal hemorrhoids:A prospective,multi-center,randomized study

BACKGROUND Endoscopic rubber band ligation(ERBL)is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain.AIM To evaluate satisfaction,long-term recurrence,and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL.METHODS This was a prospective,multicenter,randomized study.A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding(EFSB)or an ERBL group.All patients were followed-up for 12 months.Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score(HSS)and a visual analog scale(VAS).Continuous variables were reported as medians and interquartile range.RESULTS One hundred and ninety-five patients were enrolled,with 98 in the EFSB group.HSS was lower in the EFSB group than in the ERBL group at 8 weeks[4.0(3.0-5.0)vs 5.0(4.0-6.0),P=0.003]and 12-month[2.0(1.0-3.0)vs 3.0(2.0-3.0),P<0.001]of follow-up.The prolapse recurrence rate was lower in the EFSB group at 12 months(11.2%vs 21.6%,P=0.038).Multiple linear regression analysis demonstrated that EFSB treatment[B=-0.915,95%confidence interval(CI):−1.301 to−0.530,P=0.001]and rubber band number(B=0.843,95%CI:0.595-1.092,P<0.001)were negatively and independently associated with the VAS score 24 hours post-procedure.The median VAS was lower in the EFSB group than in the ERBL[2.0(1.0-3.0)vs 3.0(2.0-4.0),P<0.001].CONCLUSION Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.

Redefining hemorrhoid therapy with endoscopic polidocanol foam sclerobanding

Hemorrhoids are a common and painful condition,with conventional treatments such as endoscopic rubber band ligation(ERBL)and injection sclerotherapy often falling short due to high recurrence rates and significant post-operative pain.A clinical trial by Qu et al introduces a novel approach called endoscopic polidocanol foam sclerobanding(EFSB).This multicenter randomized trial involved 195 patients with grade II and III internal hemorrhoids and demonstrated that EFSB significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction compared to ERBL.The study's strengths include its robust design,comprehensive outcome evaluation,and patient-centered approach.Despite limitations such as the single-blind design and relatively short follow-up period,the findings suggest that EFSB could enhance clinical practice by offering a more effective and patient-friendly treatment option.Further research is needed to validate these results and explore the long-term benefits and cost-effectiveness of EFSB.

Endoscopic polidocanol foam sclerobanding for the treatment of Grade Ⅱ-Ⅲ internal hemorrhoids:The focus of clinical practice

We have read the article by Qu et al with great interest,as it presents an inte-gration of endoscopic polidocanol foam sclerotherapy with rubber band ligation in patients with Grade Ⅱ-Ⅲ internal hemorrhoids.The authors conducted a prospective,multicenter,randomized study to evaluate the long-term sympto-matic and endoscopic efficacy of this combined intervention.In this discussion,we focus on the procedural steps of this combined strategy and suggest potential avenues for future research.

Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids:A novel outpatient procedure

In the study,we comment on the article by Qu et al.Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding,prolapse,and difficulty in defecation.Endoscopic rubber band ligation(ERBL)is a safe,convenient,quick,and economical outpatient procedure.The main goal of ERBL is to alleviate prolapse,but the high incidence of recurrence and post-procedural pain are of clinical concern.Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding.Endoscopic polidocanol foam sclerobanding(EFSB)is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h postprocedural pain.The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up.Results showed that EFSB is a novel therapy for internal hemorrhoids,but future studies with a larger sample,multiple treatment sessions,and long-term follow-up are required to confirm these findings.

Rectal ulcers and massive bleeding after hemorrhoidal band ligation while on aspirin

Endoscopic hemorrhoidal band ligation is a well-established nonoperative method for treatment of bleeding internal hemorrhoids(grade 1 to 3). It is a safe and effective technique with a high success rate. Complications with this procedure are uncommon. Although rectal ulceration due to band ligation is a rare complication, it can cause life-threatening hemorrhage especially when patients are on medications which impair hemostasis like aspirin or non steroidal antiinflammatory drugs. We present 2 cases of massive lower gastro-intestinal bleeding in patients who had a band ligation procedure performed 2 wk prior to the presentation and were on aspirin at home. Both the patients were hemodynamically unstable requiring resuscitation. They required platelet and blood transfusions and were found to have rectal ulcers on colonoscopy done subsequently. The rectal ulcers corresponded to the site of band ligation. The use of aspirin by these patients would have caused defects in the hemostasis and may have predisposed them to massive bleeding in the presence of rectal ulcers occurring after the band ligation procedure. Managing aspirin before and after the ligation may be difficult especially since adequate guidelines are unavailable. Stopping aspirin in all the cases might not be safe and the decision should be individualized.

橡皮圈联合金属夹的内牵引技术在内镜黏膜下剥离术中的临床应用

目的分析橡皮圈联合金属夹的内牵引技术在内镜黏膜下剥离术(ESD)中的应用效果。方法选取2022年1月至12月赣州市人民医院收治的行ESD治疗的60例患者为研究对象,采用随机数字表法将其分为对照组与观察组,各30例。对照组采用传统ESD治疗,观察组采用橡皮圈联合金属夹的内牵引技术辅助ESD治疗。比较两组的手术情况、并发症、随访情况。结果两组的病灶面积、一次性完整切除病变率、并发症发生率及复发率比较,差异无统计学意义(P>0.05)。观察组单位时间切除率高于对照组,黏膜暴露到完整剥离时间、手术时间、住院时间短于对照组,差异有统计学意义(P<0.05);随访3个月,两组均无原发病灶残留,内镜复查显示手术创面均愈合良好;均未出现复发。结论橡皮圈联合金属夹的内牵引技术在ESD中作用明显,可充分暴露创面视野,有助于提高剥离精准度,缩短手术时间,能够减少ESD手术并发症及麻醉发生风险,促进恢复,临床应用价值较高,值得临床行大力地推广与应用。

内镜下串联套扎术与痔核套扎术治疗内痔的效果比较

目的比较内镜下串联套扎术与痔核套扎术治疗内痔的疗效和并发症。方法回顾性分析2021年11月-2023年3月该院消化内科因便血住院治疗的120例Ⅰ~Ⅲ度内痔患者的临床资料。根据手术方式的不同,将接受内镜下痔核套扎术治疗的60例患者分为对照组;将接受内镜下串联套扎术治疗的60例患者分为治疗组。比较两组患者术后6个月内痔出血的治疗有效率、内痔脱垂疗效和术后并发症发生率。结果治疗组与对照组内痔出血的治疗有效率均为100.00%;治疗组治疗Ⅱ度内痔脱垂的疗效与对照组相当,差异无统计学意义(P>0.05),但治疗组治疗Ⅲ度内痔脱垂的疗效明显优于对照组,差异有统计学意义(P<0.01);治疗组术后肛门坠胀感的发生率高于对照组,差异有统计学意义(P<0.05);两组患者术后肛周疼痛、尿潴留和控便异常等并发症发生率比较,差异均无统计学意义(P>0.05),两组患者术后均未发生血栓性外痔等。结论内镜下串联套扎术与痔核套扎术治疗内痔出血的近期疗效相似,均能取得理想效果;两者治疗Ⅱ度内痔脱垂的近期疗效相似;内镜下串联套扎术治疗Ⅲ度内痔脱垂的近期疗效明显优于痔核套扎术;治疗组术后肛门坠胀感发生率高于对照组,其余并发症无明显差别。

耳穴压豆联合康复新液保留灌肠治疗内痔套扎术后溃疡的效果观察

目的:探讨耳穴压豆联合康复新液保留灌肠治疗内镜下内痔套扎术后(ERBL)创面溃疡的效果及对病人术后疼痛、生活质量的影响。方法:选取2022年6月—2023年8月在医院接受ERBL治疗的80例内痔病人为研究对象,按随机数字表法将病人分为观察组和对照组,每组40例。对照组给予康复新液保留灌肠治疗,观察组在ERBL术后给予康复新液保留灌肠+中医耳穴压豆法治疗。分别于病人术后第24小时、第3天、第7天、第12天应用视觉疼痛模拟评分量表(VAS)对病人的疼痛程度进行评价;病人出院时采用生活质量量表(GQOLI-74)、护理满意度调查表评价两组病人生活质量和护理满意度;比较两组病人创面愈合时间、疗效、并发症情况。结果:观察组病人术后第3天、第7天VAS评分低于对照组(P<0.05);观察组病人GQOLI-74评分及护理满意度评分高于对照组(P<0.05),创面愈合时间短于对照组;观察组病人临床有效率远高于对照组(P<0.05);两组病人住院期间并发症发生率比较差异无统计学意义(P>0.05)。结论:耳穴压豆联合康复新液保留灌肠能缓解病人ERBL术后疼痛,提高病人住院期间的生活质量和护理满意度,从而提高短期疗效,安全可靠。

内镜下橡皮圈联合尼龙绳结扎剥离术治疗胃固有肌层小肿瘤临床价值分析

目的探讨内镜下应用橡皮圈联合尼龙绳结扎剥离的方法治疗胃固有肌层来源小肿瘤的安全性、有效性和可行性。方法选择36例经超声内镜(EUS)明确肿瘤(长径≤12 mm)来源于胃固有肌层的患者,在内镜下先用橡皮圈套扎,而后使用尼龙绳在橡皮圈的底侧进行结扎,然后进行剥离治疗,记录术中术后出血、穿孔情况及标本大小,对切除物行病理免疫组织化学检查,并于术后3、6及12个月进行胃镜复查及EUS随访。结果36例病变均一次性完整剥离,手术平均操作时间(15±2)min,术中出血量<2 ml,标本大小5 mm×6 mm^10 mm×11 mm,术后无出血及穿孔发生,术后病理免疫组化确诊胃平滑肌瘤10例,胃间质瘤26例(危险度分级:均为极低)。术后随访12个月,所有病例未见复发及转移。结论内镜下应用橡皮圈联合尼龙绳结扎剥离的方法治疗胃固有肌层来源的肿瘤显示了一定的安全性、有效性和可行性,但尚需要进行大规模临床研究及长期随访进一步明确其治疗价值。

改良ESD联合橡皮圈套扎切除治疗胃固有肌层小肿瘤的临床研究

目的探讨改良内镜黏膜下剥离术(ESD)联合橡皮圈套扎切除治疗胃固有肌层小肿瘤的疗效及安全性。方法选择经超声内镜(EUS)明确肿物(6 mm≤长径≤13 mm)来源于胃固有肌层的92例患者,在对患者实施静脉麻醉且气管插管状态下,先采用改良的ESD剥离小肿物,暴露到一定程度后,采用橡皮圈套扎肿物,然后进行圈套器套扎切除。观察术中术后出血、穿孔情况,观察肿物切除的完整性、标本大小,对标本进行病理及免疫组化检查,术后对患者进行6及12个月的胃镜及EUS随访。结果 92例胃固有肌层小肿瘤均一次完整切除,手术平均操作时间(19.2±2.3)min,术中平均出血量(2.6±0.5)m L,切除后穿孔3例,均于内镜下金属止血夹联合尼龙绳结扎闭合创面。术后观察1周均无迟发性出血、穿孔等情况发生;标本大小6 mm×5 mm^13 mm×12 mm,术后病理诊断胃间质瘤73例(均为极低危险度),胃平滑肌瘤18例,胃神经纤维瘤1例;术后随访12个月,均未见残留、复发等情况。结论改良ESD联合橡皮圈套扎切除治疗胃固有肌层小肿瘤的疗效确切、安全,可完整切除病变,得到完整的病理学诊断资料,对评估肿瘤性质、恶性程度及患者预后有一定的意义。

CRH O′Regan套扎法治疗Ⅰ～Ⅲ度内痔的临床观察

目的：探讨CRH O′Regan套扎法治疗内痔的临床疗效及安全性。方法：对414例Ⅰ～Ⅲ度内痔患者行痔上黏膜套扎治疗,治疗结束后第15天判断疗效并进行临床分析。结果：CRH O′Regan套扎法治疗内痔414例,完成治疗后15 d判断疗效,痊愈385例（93.0%）,有效22例（5.3%）,无效7例（1.7%）,有效率98.3%。治疗后出现肛门坠胀感47例（11.3%）,少量出血23例（5.6%）,无术后疼痛、大量出血、感染等严重并发症。结论：CRH O′Regan套扎法能较好的治疗Ⅰ~Ⅲ度内痔,安全有效,微创无痛,操作方便。

滑坡变形的三维可视化研究

基于3D GIS技术,结合一个具体的滑坡变形监测工程实例,采用不规则三角网和等高线构建了滑坡体三维模型;对于mm级的变形,通过放大和橡皮筋动画技术,在三维空间再现了滑坡的微观变形过程。

套扎法治疗痔疮的国内外进展

回顾和分析近代以来套扎法治疗痔疮的国内外文献,总结归纳了套扎法治疗痔疮的历史、适应症与禁忌症、技术原理、疗效和国际评价,以及在该领域的地位,并指明该法的优势所在及其新进展。

李柏年教授应用挂线疗法治疗肛瘘经验

李柏年教授是南京中医药大学第三附属医院肛肠外科主任医师,国家级名老中医,全国名老中医药专家学术经验传承导师,从事肛肠外科科研与临床工作52年,尤其擅长高位复杂性肛瘘的诊治,对挂线疗法有独特的经验,值得我们学习和借鉴。

中医挂线疗法治疗高位肛瘘临床研究

目的:探讨不同时间段橡皮筋脱落与手术前后肛门功能之间的关系,以及对各个时间段肛门功能的评估,得出合适的橡皮筋脱落时间段。方法:对62例高位肛瘘病例,行低位切开高位挂线术。以术后橡皮筋脱落时间为分组依据。试验1组橡皮筋脱落时间<10 d;试验2组11 d≤橡皮筋脱落时间≤16 d;试验3组橡皮筋脱落时间>16 d。观察手术前后的肛门直肠压力测定(静息压、收缩压、排便压改变率)、痊愈后wexner评分、随访0.5 a复发率。结果:痊愈时对比直肠肛管压力测定改变率试验1组与试验2组组间比较,差异有统计学意义(P<0.05),痊愈后wexner评分统计分析结果,试验1组与试验2组组间比较,P=0.00<0.05,差异有统计学意义。结论:挂线治疗高位肛瘘中橡皮筋的脱落时间与术后肛门功能之间存在关联,当橡皮筋脱落时间在11 d到16 d之间时,痊愈后wexner评分以及直肠肛管压力测定改变率均明显低于橡皮筋脱落时间小于10 d时。即挂线橡皮筋在这个时间范围脱落,对肛门括约肌功能保护较试验1组理想。