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Banding Bulletin – May 2012

Banding Bulletin – May 2012

We hope this month’s edition of the “Banding Bulletin” finds you well! This month, our clinical tip will focus on banding a single column per setting. We’d also like to invite everyone to DDW and share some of the results from our annual survey.


If you plan to attend DDW in San Diego this year, we would love to see you! Please come by and visit us at our booth – #3122, Sunday through Tuesday, May 20-22, from 10:00am until 4:00pm. We will also be in the Learning Center on Sunday and Monday from 10:00am – 2:00pm for “hands-on” demonstrations. Both Dr. Andy Gorchynsky and I will be there as well as staff from Business Development and Practice Support. We will be happy to address any questions about our training and technology, as well as to provide you with all the information you might need regarding the CRH O’Regan System®. We hope to see you there!

CRH Annual Survey

We have just finished compiling the results from our annual survey sent to our partner physicians. We are extremely pleased with the responses and would like to share some of them with you:
Our Partners report their top reasons for incorporating the CRH O’Regan System® into their practices were:

  1. It’s ease of use
  2. The efficiency of the procedure
  3. The low complication rate (1%)
  4. The ancillary revenue generated by the procedures

In addition, 90% of physicians and staff indicated that the complimentary marketing resources we offer (patient brochures, wall charts, table tents etc…) are useful to their practice. We’d also like to congratulate Pat Schnipke of Gastro-Intestinal Associates who won this year’s iPad. We hope that you will be a trained partner taking part in next year’s survey!

Clinical Tip – “One at a time, please!”

The most frequently asked clinical question in the recent CRH Survey revolved around the recommendation to band a single hemorrhoidal column at a setting. This recommendation stems from the data revealing an increased rate of complications when more than one column is addressed at a time. I will include a paragraph from our recent paper, which can be accessed HERE:

The next controversial point involves the number of hemorrhoids to be treated in a single session. Barron, in his initial presentation, found that by banding one column of hemorrhoids at a time, his patients experienced less pain and fewer problems in the post-banding period. These advantages were felt to outweigh the disadvantage of requiring multiple sessions separated by a period of several weeks. Other authors have echoed this sentiment, but some have challenged this practice in an effort to see whether multiple bandings could be employed in an attempt to treat all of the disease in a single session. Multiple–banded patients experienced a significant increase in pain, need for analgesics, urinary symptoms, vasovagal symptoms, and swelling and edema compared with those having only one column banded. An attempt to minimize this increased incidence of pain by injecting the banded tissue with local anesthetic was found to be unsuccessful. Based upon the above, the current recommendations are that a single column of hemorrhoids be treated in a given session . . .

Guttenplan M, Ganz RA. Hemorrhoids – Office Management and Review for Gastroenterologists.; December, 2011.

Dr. Cleator’s WORK demonstrated that by banding a single column of hemorrhoids at a time, the complication rate was held to only 1%, as opposed to a minimum of 6-10% when multiple sites are treated at a setting

It is for these reasons that, in our practices, we’ve kept to the “one at a time” rule when caring for our patients. We feel this strategy, along with an evaluation and aggressive medical treatment of associated clinical issues (anal fissures, anal spasm, skin rashes, etc.) has been responsible for the outstanding clinical results that have been demonstrated in our Partner practices.

Please let us know if you have any topics that you’d like addressed in future “Banding Bulletins”, and please also visit our ARCHIVE of past Bulletins, where other clinical tips have been presented. Please also let ME know if you are interested in being trained in the use of the CRH O’Regan System®, if you would like a “refresher” visit and session, or if you have any partners or colleagues that may be interested – we are always happy to add to our growing list of Partners throughout the U.S. and beyond!

Best regards,


Mitchel Guttenplan, MD, FACS

Medical Director

CRH Medical Corporation

T: 800.660.2153 x1022 | C: 770.363.0125 | F: 770.475.9953

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