Endoscopic Variceal Ligation (Banding)

What Are Esophageal Varices?

Esophageal varices are enlarged veins in the lower part of your esophagus (the tube that carries food from your mouth to your stomach). These happen when the liver becomes damaged, usually due to conditions like cirrhosis. When the liver doesn't work properly, it can cause increased pressure in the blood vessels which leads to these veins swelling up. These swollen veins are at risk of bleeding, which can be serious.

About 1 in 3 people will experience a significant bleed at some point, and if bleeding happens, it can be life-threatening, with a 30-50% chance of death during the first episode. If a person survives, there's a 60-70% chance they could bleed again within a year, and the second bleeding can also be deadly.

What is Endoscopic Variceal Ligation/ Banding (EVL)?

EVL, or banding, is a procedure used to treat these enlarged veins. It helps stop or prevent bleeding. This procedure uses small rubber bands to tie off the varices, cutting off their blood supply and preventing them from swelling and bleeding.

When is it used?

EVL is mainly used when there is an active bleeding from esophageal varices (emergency lifesaving procedure) or if there is a high risk of future bleeding (elective procedure). The goal is not only to stop any current bleeding but also to prevent future episodes. After a well-managed bleeding episode, one may need to undergo multiple periodically planned banding sessions to ensure complete eradication of varices and to reduce the risk of recurrent bleeding.

Who shouldn't have this procedure?

If a patient has certain conditions, like

• Active infection- fever due to any reason
• Throat infection or persistent cough
• Tense abdomen due to gross fluid in abdomen, can be done after tapping (fluid removal)
• On blood thinners or having bleeding tendency

Possible complications

While the procedure is generally safe, there can be risks. These include difficulty swallowing or chest pain. It is important to monitor for these complications closely.

The EVL Procedure: What to Expect

Preparation: Before the procedure, your healthcare team will make sure everything is in place:

• They will ensure all equipment is working correctly and ready for use.
• You'll be asked not to eat or drink for 4-6 hours before the procedure.
• The healthcare team will confirm you've given consent for the procedure and, if needed, antibiotics or blood will be ready in case of complications.

During the Procedure: EVL is performed using an endoscope (a thin, flexible tube with a camera) to view the varices. The doctor will use a special tool to place small rubber bands around the varices to cut off their blood supply. The procedure is usually done under sedation, so you won't feel pain. The procedure can also be performed without sedation. In situations such as active bleeding, a history of vomiting blood or passing black stools, or during emergency endoscopy, sedation is usually avoided. This is due to the presence of blood in the stomach, which can be coughed up and may lead to aspiration into the lungs.

Post-Procedure Care: After the procedure, you'll be monitored to make sure everything is okay. Your healthcare team will watch for signs of bleeding, chest pain, or difficulty breathing. You may feel a little discomfort and will need to rest.

• In many cases, multiple banding sessions are needed. Ligations may be repeated in 7-14 days and then every three to four weeks until varices are obliterated.

Aftercare and Follow-Up:

• Watch for signs of complications: After EVL, it is important to keep an eye out for problems such as chest pain, fever, trouble breathing, or if you feel like something is not right with your swallowing.
• Full liquid to soft diet for the first 24 hours after the banding procedure if ordered by physician.
• Follow-up care: You will likely need several follow-up appointments for monitoring/ additional banding to ensure the varices are fully treated.
• What to do if bleeding returns: In the case of a re-bleed, your doctor may suggest other treatments to control the bleeding and prevent further complications.

* Communicate openly with your healthcare provider and follow all the instructions they give to ensure the best possible outcome.

Disclaimer: Some portions of this content may be derived from publicly available sources on the internet.