# Clinical utility of a novel double-band endoscopic band ligation device for consecutive ligation in the management of diverticular bleeding

## TL;DR

A new endoscopic device allows two ligations without removing the scope, improving treatment for diverticular bleeding.

## Contribution

The first clinical case report of a novel double-band endoscopic band ligation device for consecutive ligation.

## Key findings

- The device enabled a second ligation without removing the endoscope, despite the first band dislodging.
- The procedure was completed in 27 minutes with minimal bleeding and no adverse events.
- The device shows potential for managing challenging cases of diverticular bleeding.

## Abstract

Endoscopic band ligation is effective for diverticular bleeding; however, conventional devices have drawbacks such as limited visibility, weak suction, and single-use design. Endoligar (Asahi Intecc Co Ltd, Aichi, Japan) addresses these limitations with clear visibility, strong suction, and the ability to perform 2 ligations without removing the endoscope. This report evaluates its clinical utility.

An 82-year-old man with a history of diverticular bleeding was admitted for hematochezia lasting 3 days. Noncontrast computed tomography and emergency colonoscopy suggested a bleeding diverticulum in the ascending colon. A diverticulum at the hepatic flexure showed signs of a recent hemorrhage, but no active bleeding; a clip was placed for marking. On day 8, a second colonoscopy showed oozing from the previously marked diverticulum, and endoscopic band ligation was performed using the novel device. The first band dislodged, but a second ligation was completed without scope removal.

The procedure lasted 27 minutes, with minimal bleeding and no adverse events. The patient was discharged on day 13.

This is the first clinical case report on this device, to our knowledge. The device enables a second ligation without scope removal, reducing the risk of losing the lesion, and is potentially useful in challenging endoscopic band ligation cases. Further studies are required.