title: Endoscopic band ligation for colonic diverticular bleeding: possibility of standardization.
abstract: OBJECTIVE
  Endoscopic band ligation (EBL) has been used to achieve hemostasis in patients with colonic diverticular bleeding. The safety and effectiveness of EBL when performed by non-expert endoscopists have not been sufficiently verified. This study aimed to elucidate the feasibility of the EBL technique when performed by non-expert endoscopists and of considering EBL as a standard treatment for colonic diverticular bleeding.
  
  
  METHODS
  A retrospective cohort study was conducted in a tertiary referral center in Tokyo, Japan, between June 2009 and October 2014. A total of 95 patients treated with EBL were included in the study and were divided into two groups according to whether they had been treated by expert or non-expert endoscopists. Comorbidities, medications, shock index, hemoglobin level on admission, location of the bleeding diverticula, rate of bowel preparation, procedure time, and EBL-associated adverse events were evaluated in each group. Multivariate linear regression analyses were used to investigate factors related to EBL procedure time, which is the time elapsed between marking the site of bleeding with hemoclips and completion of the band release.
  
  
  RESULTS
  A total of 47 (49.5 %) procedures were performed by expert endoscopists. In a bivariate analysis, the median EBL procedure times in the expert and non-expert groups were 15 minutes (range 4 - 45) and 11 minutes (range 4 - 36), respectively (P = 0.03). When a multivariate linear regression model was used, EBL for right-sided diverticula was the factor most significantly affecting EBL procedure time. No adverse events were encountered.
  
  
  CONCLUSIONS
  EBL can be safely and effectively performed by non-expert endoscopists. A right-sided location of diverticula was the factor most significantly affecting EBL procedure time.
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Yuto
authors.initials: Y
authors.lastname: Shimamura
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishii
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Omata
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Noriatsu
authors.initials: N
authors.lastname: Imamura
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okamoto
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Ego
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Nakano
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ikeya
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Fukuda
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujita