About Variceal Banding

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Variceal banding, also known as endoscopic variceal ligation (EVL), is a procedure used to treat esophageal varices, which are enlarged veins in the esophagus often associated with liver disease, particularly cirrhosis. These varices can rupture and cause life-threatening bleeding.

What is Variceal Banding?

  • It involves using an endoscope (a flexible tube with a camera) to access the esophagus.
  • During the procedure, small rubber bands are placed around the enlarged veins (varices), cutting off the blood flow to the varix, which eventually causes it to shrink and scar over.
  • This prevents further growth and reduces the risk of rupture and bleeding.

Indications for Variceal Banding:

  1. Prevention of bleeding (primary prophylaxis) in patients with high-risk varices (e.g., those with liver cirrhosis).
  2. Treatment of active bleeding from varices (secondary prophylaxis).
  3. Recurrent variceal bleeding despite other medical management.

Procedure:

  1. Preparation: The patient is typically sedated. They may be given medications to reduce stomach acid and help with sedation.
  2. Endoscopy: A gastroenterologist inserts an endoscope through the mouth into the esophagus.
  3. Banding: When a varix is identified, a rubber band is placed around it. This causes the varix to be cut off from its blood supply, shrinking over time.
  4. Follow-up: Multiple sessions may be required to fully treat the varices, and patients may require regular surveillance endoscopies.

Risks and Complications:

While variceal banding is generally safe, there are risks, including:

  • Bleeding (usually minor and self-limiting).
  • Ulceration at the site of the band.
  • Infection.
  • Dysphagia (difficulty swallowing) in the days following the procedure.

Aftercare:

  • Patients are typically advised to avoid solid foods for a few hours and then transition back to a regular diet gradually.
  • Medications such as beta-blockers may be prescribed to lower portal pressure and further reduce the risk of variceal formation.

Effectiveness:

  • Variceal banding is highly effective in preventing rebleeding from esophageal varices and is one of the main treatments for managing variceal hemorrhage.