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Banding Bulletin – May 2017

Banding Bulletin – May 2017

We hope that this edition of the Banding Bulletin finds you well!  In this piece, we’ll be reviewing our most frequently asked question, introduce our new Clinical Support Specialist and provide some DDW information for those of you traveling to Chicago for the conference.  We’ll also include some information regarding the CRH Medical app for iOS and Android as well as for CRH Anesthesia.

FAQ – Anticoagulants and Band Ligation

This is, BY FAR, the most frequently asked question we receive; unfortunately, there is little data in the literature to help us.  Here are a few things we DO know:

  • Some authors state that anticoagulation is a contraindication to band ligation, and others are less certain, as most of the studies out there have little data to back up their recommendations.
  • There are no good guidelines presented by any of the national organizations, and there are no data that I’m aware of dealing with banding alongside the newest generation of anticoagulants.
  • If patients are going to bleed after a band, they typically do not bleed on the day of the banding . . . rather most frequently at 10 days to 2 weeks after a banding, and less likely in the 3 to  6 day range.  Significant bleeding on the day of a banding is quite rare.
  • We can stop bleeding from the banding site if it occurs in a patient taking anticoagulants, but I can’t stop a CVA or an MI if we’ve stopped anticoagulation.
  • One study did suggest that stopping warfarin and bridging the patient with a sub-q preparation was riskier for bleeding than leaving the patient on their warfarin (again, with a small sample size).
  • Dr. Cleator banded 150 times with the patient taking warfarin, with one patient bleeding post-banding, and the bleed did not occur from the banding site but rather from a coexistent fissure.
    Our practice has been to not stop 81mg ASA in and around a ligation and we have not found this to be an issue.

Nelson’s group, looking at the timing of most post-banding bleeds, recommended that for those cases in which you are going to hold anticoagulation, you do not hold the medication until the day of the procedure, and then keep them off of their medication for 7 days if on warfarin and 10 days if on clopidogrel or aspirin.

For a further discussion of this topic along with our own personal experience, please click HERE.

Welcome Mia!

Please join me in welcoming our new Clinical Support Specialist, Mia Nguyen!  Mia is an RN located in Atlanta, Georgia and will join us in travelling around the country to work with practices utilizing the CRH O’Regan System.  Her addition to the team means we are that much more prepared to better serve your practice!

If you would like to have us back for a “refresher” session to address any clinical questions, help refine technique or provide some tips/tricks, please contact ME or your account manager.

CRH Anesthesia Management

A few weeks ago, CRH Anesthesia Management proudly announced another acquisition, this time in Florida, as well as our first agreement to develop and manage a MAC program with a group in Washington State.  With these agreements in place, CRH now provides anesthesia for GI cases in 27 ASCs in 7 States, providing care for approximately 185,000 cases annually.

We are looking to continue to grow and expand our footprint; if you currently have an anesthesia program and are interested in monetizing some of the equity you’ve built, we’d love to talk to you about some of the options available to you.  If you do not have your own anesthesia service, we can show you how we can develop a program at your practice.  For more information, please contact CARTER BLANTON, our VP of Business Development for CRH Anesthesia Management, or ME!

CRH Adds Educational Content to Website and CRH App!

We are happy to announce that we have updated some of the educational video content found on our website –  The new content provides technical demonstrations and addresses a host of FAQs.  This sits alongside links to a host of resources available to you and your practice.

Much of this material has also been made available to you by way of our CRH Medical App, available for iOS and Android.  Download this app to your smart phone or tablet, and have access to most everything you need to help care for your patients’ perianal complaints!

Come Visit Us at DDW!

We’re looking forward to DDW this weekend and would love to see you there!

  • Visit us at booth #3826 all weekend
  • Try out the CRH O’Regan System at the hemorrhoid therapies hands-on course May 6th @ 8-10am
  • Learn more about the CRH O’Regan System and CRH Anesthesia Management with speakers Mitch Guttenplan, MD and Jay Kreger at our product theater presentation on May 8th @ 1:15-2pm
  • Dr. Waqar Qureshi (Baylor Medical) and I helped to develop a new video for the ASGE that will be available in the “Learning Center”, titled “Evaluation of the Anorectum:  Physical and Endoscopic Examinations”.  Please have a look and let us know what you think!

Thanks for checking out this edition of the Banding Bulletin!  Have a great week and we’ll hope to see you in Chicago!

Best, Mitch

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