Banding Bulletin – August 2013
Welcome to this edition of our “Banding Bulletin”! We hope that you’ve been having a great summer, and that you are ready for things to pick up as the vacation season comes to a close. In this Bulletin, we’ll include a Case Study as well as a summary of CRH’s recent survey results.
I’d also encourage you to take full advantage of all of the marketing and informational material that is available to you, and make certain that you are listed on the CRH website. BRIANNE will work with you to make certain that you are well cared for in these regards.
If you are interested in an initial or “refresher” training session, please feel free to contact JESSICA or ME, and we’ll work to get you back on our calendar!
Everyone at CRH would like to express their thanks to those of you who have completed our recent survey – we were able to gather some valuable information from your responses. Some of the more interesting results included:
- The top 3 reasons for adopting the CRH technology — Ease of use, efficiency of procedure, and low complication rate.
- 86% utilize the technology primarily in the office setting.
- 92% anticipate using the technology at least as often as they currently do (61% plan on increasing their usage).
- 82% include patient discussion and education regarding treatment when symptomatic hemorrhoids have been diagnosed endoscopically.
- The most common sources of patients include: (1) Those diagnosed at time of colonoscopy; (2) Those from physician referrals; (3) Those from word of mouth and from the use of CRH marketing materials (tied).
We were also thrilled with the level of satisfaction reported in regard to our marketing and informational materials along with our website!
We are constantly striving to provide the best possible support and service — your feedback and suggestions have been VERY helpful in this regard. Please keep your suggestions and comments coming, and thanks for all of your support! We’d also like to congratulate Kim Sherman with “Medical Specialists of the Palm Beaches” in Atlantis, FL as the winner of the Best Buy gift card! Thanks again to everyone who participated!
Case Study – Post-banding Pain
An otherwise healthy 54-year old man with large, symptomatic grade II hemorrhoids (recurrent bleeding, itching, leakage) had his Left Lateral and Right Anterior hemorrhoids banded at 2 week intervals without incident, presenting for his Right Posterior banding. The procedure was done without difficulty, and the patient left the office with a bit more pressure than the previous 2 sessions. The patient was almost back home when he called stating that he was having some more significant pain, and was told to return to the office. Digital manipulation of the banded tissue allowed the band to slip a bit, freeing up some of the previously banded tissue, completely resolving the patient’s pain. He went back home and had an uneventful course thereafter.
As documented by the work of Dr. Iain Cleator, the complication rate, when using the CRH O’Regan System as recommended, is 1% (pain being one of those complications). There are several things to keep in mind in order to ensure you see pain statistics as low as this:
- Make certain that the patient is absolutely pain-free at the time of discharge from your office. A sense of pressure or some mild tenesmus after a banding is common, and typically resolves within a few hours. A “pinching” sensation or pain of any magnitude may well progress with time, and it is important to make certain that the patient understands this. If the patient reports ANY pain, ANY “pinch”, or looks at all uncomfortable — then manipulate the banded tissue until those sensations have disappeared. Consider keeping the patient waiting around for 5 – 10 minutes after the banding as this will give them a chance to differentiate between the normal pressure and something which needs to be addressed. You may also want to enlist your front office staff to quiz the patient prior to leaving in order to make certain that they are comfortable.
- Do not band too low, too many or too much! In order to keep the possibility of pain to a minimum, band one column of hemorrhoids at a setting, place the bands nice and high (2cm or more above the dentate line), and make certain that the banded tissue “moves” freely, with a narrow “neck” to assure that the muscularis was not trapped in the band.
- Treat patients’ “spasm”! This part of the discussion is completely “off-label”!!! When evaluating the patient, we look for signs of a “subacute” or healing fissure, or patients with other signs of spasm. If the patient demonstrates any of this, we will use topical nitrates (or calcium channel blockers). These medications seem to relieve whatever symptoms that result from these issues, and the patients seem less likely to experience pain after banding.
- Rarely, post-banding thrombosis (usually of an external hemorrhoid) will occur. These should be treated the same as any thrombosis, and the symptom complex of pain, fever and urinary retention would raise the possibility of infection.
Thanks again for your interest and support! Please let us know if we can help in any way, and we’ll be back in touch soon.
Mitchel Guttenplan, MD, FACS
CRH Medical Corporation
C: 770.363.0125 F: 770.475.9953