We are very happy to bring you the November edition of the “Banding Bulletin”! October was a very busy month with both the American College of Surgeons and the American College of Gastroenterology annual meetings taking place. As always, we were pleased to be able to speak with so many of our Partner Physicians (as well as meet with physicians who are just learning about our technology) at both of these conferences. It is always great to catch up with the practices that we’ve visited, and to hear all of the positive feedback they’ve received from the use of the CRH System! Andy Gorchynsky and I join everyone from CRH in thanking you for your continued interest and support!
In this edition, we’ll address one of the most frequent questions that we are faced with, and add in an operational tip or two in order to see if we can help your practice into the New Year!
The end of the year rush is here!
Thanksgiving is almost here, and many of your patients’ healthcare deductibles have been met – meaning that the inevitable rush to get into your offices in order to take care of all of their needs before the end of the year is ON! CRH would like to extend an offer to help you and your practice. Robbie and Brianne are available to share innovative ideas and best practices in order to increase your efficacy and efficiency. We’re happy to work with your schedulers, billers, front and back office staffs as well, in order to help maximize your efficiency and help optimize the clinical results that you see in your patients.
Are you interested in a refresher session?
Andy and I would both love to visit with you and your practice in order to have a bit of a “refresher” session. These sessions allow for a Q&A to see if we can help you to “brush up” on your banding technique, review some of the recommended treatment protocols, and to see if there is any way that we can help you to better care for your patients. We can also arrange to set up a conference call, video conference or “webinar” in order to present you with all of the information you might need. Please contact ME and we will get you on our calendar!
Case Study – Banding in patients taking anticoagulants:
We’ve received several questions relating to the use of anticoagulants in the past month, so I’ll cut to the chase and get right to the recommendations and rationale behind them. I need to preface the following by noting that I have found a lot of recommendations pertaining to the use of RBL with anti coagulated patients, but very little data behind those recommendations — but I’m still looking!! Almost uniformly, if recommendations are made, they are to (if appropriate) take the patients off of their anticoagulation prior to banding them. There have been a few that have endorsed the use of RBL in anticoagulated patients, but without data or citations to studies which back these recommendations up.
In fact, one of the few authors commenting on this was Dr. Iain Cleator, of Vancouver, BC, Canada. In his study, he reported on the banding of 60 patients on Coumadin, and one that was heparinized. A total of 150 bandings were performed, and of those, only one patient had a significant bleed which was treated with cautery. A link to that monograph is HERE.
There certainly are risks involved in the discontinuation of a patient’s anticoagulation — the risks being dependent upon the issue for which that patient is being anti coagulated and the severity of that issue. It has always been our practice to speak with the physician responsible for the medication to make certain that it was alright for us to hold their Coumadin, Plavix, etc. So, until there is more evidence to the contrary, the recommendation is that, if safe to do so and if appropriate, anticoagulation should be held 4 or 5 days prior to performing a RBL. Given the current information that is available, and until evidence to the contrary can be gathered, it seems reasonable to consider anticoagulation as a relative contraindication to RBL. We certainly know of a number of patients taking Coumadin or Plavix that have been banded — typically patients with more severe disease, in whom the potential increased risk is more than offset by the severity of their problems.
When reviewing these topics a couple of years ago in a previous Bulletin, Dr. Tom Deas was kind enough to refer me to a “position paper” by the ASGE in regards to the use of anticoagulants in patients undergoing GI procedures. RBL was not specifically addressed, but the general guidelines are quite helpful. A link to the paper is HERE. It would be wonderful to see a study which addresses this issue more directly, but until we find that, the information above seems to be the most up-to-date.
Happy Thanksgiving to everyone!
Here’s wishing everyone a happy and healthy Thanksgiving! We hope that everyone is able to enjoy the day and the holiday season that follows! We’ll be back to you before the Holidays with our next edition of the “BB”, but please let us know if we can help with anything in the meantime!
Best,
Mitch
Mitchel Guttenplan, MD, FACS
Medical Director
CRH Medical Corporation
T: 800.660.2153 x1022 | C: 770.363.0125 | F: 770.475.9953
