Endoscopic Band Ligation of Esophageal Varices

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Elastic band ligation is considered the best procedure for the treatment of esophageal varices. These arise in patients who have increased pressure in the portal vein (portal hypertension), which has several causes, with the main one being hepatic cirrhosis.

The procedure is performed to prevent the rupture of these vessels, thus avoiding episodes of gastrointestinal bleeding. It is also used to stop bleeding that has already been caused by a variceal rupture.

Every patient with esophageal varices should undergo periodic monitoring with their doctor, who, in addition to prescribing medications, may request elastic band ligation of the varices when necessary.

During the procedure, the patient is sedated as with all digestive endoscopies. A ligation device is then attached to the tip of the endoscope, with the elastic band trigger handle at the other end of the endoscope, where the endoscopist performs maneuvers with the device.

After the introduction of the device, the endoscopist identifies the dilated veins (varices) and sucks the point to be ligated into the device. After this, the ligation device is rotated, releasing the rubber band, which strangles the portion of the varix that was sucked in.

This strangulation causes the varix to decrease in size until it “dries up.” This process takes about 2 weeks. Sessions are usually repeated every 15 days until the varices disappear. Generally, 3 to 6 sessions are required for complete treatment.

After the procedure, the patient may feel some discomfort swallowing on the first day, which is normal and subsides in about 3 days. Therefore, during this period, the patient should have a liquid diet and then a soft diet. They should also avoid hot foods and liquids that can cause the rubber bands to come off prematurely and predispose to bleeding.

Guidelines for the exam:

• The presence of an adult companion from the time of arrival until the end of the procedure is an indispensable condition for the performance of variceal ligation. In the case of patients under 18 years of age, the companion must necessarily be a legal guardian.
• To undergo variceal ligation, the patient must have recent results of complete blood count, prothrombin time (PT), and platelet count. In addition, previous endoscopy reports must be presented.
• Medications with ASA (aspirin) and anticoagulants, such as warfarin (Marevan®, Coumadin®), clopidogrel (Plavix®), and ticlopidine (Ticlid®), should be discontinued ten days before the procedure, always under the supervision of the prescribing physician.

On the eve of the procedure

The patient should have a light dinner, avoiding fatty food.

On the day of the procedure

A fast of eight hours, even from liquids.

Attention: It is not possible to perform other invasive abdominal examinations on the same day (example: colonoscopy).

The procedure lasts, on average, 40 minutes, including preparation time.

At the end of the procedure, the patient needs to rest for about an hour.

Post-procedure care:

Due to the use of anesthesia, it is not possible to drive cars or other vehicles for the entire day after esophageal variceal ligation. For the same reason, for a period of approximately eight hours after the procedure, the individual cannot perform tasks that require attention, such as working with machinery and sharp objects.

The medication used in anesthesia can cause a short period of amnesia.

The patient should rest for the remainder of the day, eating as medically recommended.

For the 3 days following the procedure, the patient should have a diet consisting only of liquids and soft foods. They should also avoid hot food and liquids.

They should also not engage in physical activity or carry weight for at least 3 days.