Endoscopic Esophageal Variceal Band Ligation
Endoscopic Esophageal Variceal Band Ligation
What is Endoscopic Esophageal Variceal Band Ligation?
Endoscopic band ligation of esophageal varices is a medical procedure performed using an upper gastrointestinal endoscope to treat esophageal varices, which are abnormally dilated veins in the wall of the esophagus. These typically occur as a result of portal hypertension due to liver disease. These veins are fragile and prone to bleeding, and bleeding from esophageal varices is one of the most dangerous and life-threatening complications.
The procedure involves placing small rubber bands around the varices to close them off and prevent blood flow, which eventually leads to the veins shrinking and collapsing.
When Do Doctors Perform Esophageal Variceal Band Ligation?
Doctors recommend this procedure in the following cases:
- When there is active bleeding from the varices.
- If medium to large varices are detected during endoscopy, especially in patients with liver cirrhosis.
- As a preventive measure in patients at high risk of bleeding due to dilated esophageal veins.
- After an initial bleeding episode, to prevent recurrence (known as secondary prophylaxis).
Preparing for the Procedure
Before the procedure, patients are typically instructed to:
- Fast for 6 to 8 hours.
- Inform the doctor about any medications being taken, especially blood thinners.
- Undergo lab tests, including liver function tests, coagulation profile, and a complete blood count.
- Discuss any chronic illnesses or drug allergies with the doctor.
Sedatives may be given before the procedure to help reduce anxiety.
Steps of Endoscopic Variceal Band Ligation
The procedure follows these steps:
- The throat is numbed with a local anesthetic spray, and the endoscope is inserted through the mouth into the esophagus.
- The doctor identifies the varices using the camera.
- A rubber band is placed around the base of each varix using a special device.
- If multiple varices are present, each is banded individually.
- The procedure typically takes 20 to 45 minutes.
After the procedure, the patient is observed for a few hours, especially if sedation was used.
Possible Complications
Although the procedure is relatively safe, some complications may occur, such as:
- Chest or throat discomfort or pain.
- Ulcer formation at the banding site.
- Minor bleeding post-procedure, usually self-limiting.
- Esophageal stricture (rare).
- Very rarely, infection or esophageal perforation.
Patients should contact their doctor immediately if they experience severe pain, continuous bleeding, or significant difficulty swallowing.
Post-Procedure Tips
The doctor resorts to this type of treatment in the following cases:
- Rest on the day of the procedure.
- Diet: Start with clear liquids for the first 24 hours, then gradually move to soft foods over the next few days.
- Avoid spicy, dry, or hard foods for at least one week.
- Completely avoid alcohol.
- Continue treatment for the underlying liver condition, especially if portal hypertension is present.
- Adhere to scheduled follow-up sessions for repeat banding if needed, as the procedure often requires multiple sessions.
What Can Patients Eat After the Procedure?
Immediately after the procedure, the recommended diet includes:
- Day 1: Clear liquids only (water, light tea, clear broth).
- Next two days: Soft, easy-to-swallow foods like yogurt, mashed potatoes, well-cooked rice.
- First week: Avoid solid, spicy, or crunchy foods.
- After a week: Gradual return to the normal diet unless otherwise advised by the doctor.
Does the Procedure Cause Pain?
Yes, it is common to experience mild pain or a burning sensation in the chest or throat during the first two days after the procedure. This is due to the banding and irritation of the esophageal lining. The pain is usually manageable with simple pain relievers like paracetamol and subsides gradually.
If the pain is severe or persistent, the patient should consult the doctor to rule out complications like ulcers or infection.
Can Esophageal Varices Be Completely Cured?
It is not usually possible to completely and permanently eliminate esophageal varices, especially if the underlying cause, such as portal hypertension, persists. However, treatments like endoscopic band ligation, combined with medical management of portal pressure (e.g., medications like propranolol or surgical options in advanced cases), can:
- Significantly reduce the risk of bleeding.
- Minimize the need for emergency interventions.
- Improve the patient’s quality of life and extend lifespan.
