Hemorrhoid Banding: The Implications of Introducing the Procedure to a GI Practice
Figure 1: The CRH O’Regan System Ligator (CRH Medical Corporation)
O’Regan System has dramatically improved on this technique. With an updated model now comprised of an integrated obturator in order to ease insertion, this ligator uses gentle manual suction to draw tissue in, making the procedure much more comfortable for the patient. Performed in an office or ASC, the treatment only takes a minute and typically allows patients to return to work the same day. Due to the efficiency of the procedure, many GIs will schedule their hemorrhoid patients in blocks, typically performing five to six procedures per hour. A typical patient will require three procedures – one for each hemorrhoidal column. Only one column is treated per visit in order to minimize the risk of complications. With this protocol, complications have shown to be less than 1% with a recurrence rate of 5% at two years.3
Incorporating the CRH O’Regan System into a Practice By Jessica Diduch With the recent reimbursement cuts to endoscopic procedures, many GI practices today are looking for ways to introduce new sources of revenue while remaining in line with their core competencies. Hemorrhoid treatment, in its various forms, has become a line JESSICA DIDUCH item for many groups over the past several years, with more realizing the opportunity every day. Due to the fact that hemorrhoids affect approximately 75% of the population at some point in their lives, gastroenterologists are now diagnosing hemorrhoids on a routine basis — many times through a colonoscopy.1 Though not life threatening, the inability to definitively treat a patient who often times has been experiencing the discomfort and embarrassment of hemorrhoids for months, if not years, can be frustrating. Providing a continuum of care to these patients not only offers economic advantages to the practice, it also allows the physician to provide relief to patients who would have otherwise had to go elsewhere, or continue to suffer.
Rubber Band Ligation The most common in-office technique for the treatment of hemorrhoids is rubber band ligation (RBL).2 RBL is widely used to treat all grades of hemorrhoids by placing a small rubber band around the apex of the hemorrhoid, causing the banded tissue to necrose and slough. The resultant scarring fixes the remaining tissue in place, keeping the hemorrhoidal tissue from prolapsing, and in doing so, eliminating the patient’s symptoms. Unlike traditional band ligation which uses metaltoothed forceps and an anoscope, the disposable CRH
Though initially something gastroenterologists were hesitant towards introducing, often because education in anorectal care had not been part of their training during their fellowship years, hemorrhoid treatment has now become a significant extension of many GI practices. CRH Medical has now trained over 2,200 gastroenterologists at 800 practices across the country, offering a complementary physician-to-physician training program and comprehensive clinical and operational support to ensure a seamless integration. The decision to incorporate a new procedure into a practice can be a balancing act, with the need to look at clinical outcomes, the ease of transition, the training required, and the economics involved. When asked what propelled them to introduce hemorrhoid banding, several physicians trained on the CRH procedure responded with their take: Dr. Reed Hogan III (GI Associates & Endoscopy Center – Jackson, MS): Anorectal disorders are grossly ignored by the GI community, and I knew I could create a niche in this market. For years, patients have been conditioned to not discuss hemorrhoids with their doctors because they’ve been given two bad treatment options: ineffective creams or very painful surgery. However, being able to offer an effective and painless alternative is just plain fun. Patients are excited and grateful. Recurring office visits with positive results creates unique and excellent physician/patient relationships. Dr. Jatin Bidani (Bardmoor Gastroenterology – Seminole, FL): I introduced CRH as there was a vacuum in the community, surgeons feel it is too small for them, and patients do not want to go to a surgeon (they have heard one too many horror stories). I could provide this service to patients who would suffer without knowing that a painless solution is available. SPR I NG 2 0 1 6 EndoEconomics
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