Band Ligation and Sclerotherapy Application to Esophageal Varices
Esophageal varices are swollen veins in the walls of the esophagus. These varices cause significant bleeding and ruptures.
The swelling of the veins is caused by the high pressure affecting the main veins (portal vein) in the abdomen (also called portal hypertension). The portal vein is the vein that carries blood from the stomach and intestines to the lungs.
Portal hypertension is usually caused by cirrhosis of the liver, Scar formation occurs when cirrhosis increases the pressure in the portal vein. Its symptoms are black discharge of solid stool (blood from the upper digestive tract) and vomiting blood.
In the past years, many treatments have been shown to reduce portal vein pressure and thus reduce the chance of bleeding in the esophagus. These treatments include daily and regular use of beta blockers and nitrates.
If a vessel in the esophagus has ruptured, there is an emergency. You may need a blood transfusion to restore normal blood volume, heart rate, and blood pressure; And if the bleeding doesn’t stop on its own, you may need treatment.
Almost half of esophageal varices are self-healing; however, the risk of recurrence is quite high. In individuals who need treatment, intravenous medication is used to compress the blood vessels and reduce the pressure ratio in the portal artery and esophagus veins.
If these methods also fail to stop the bleeding, a cable tied with a balloon is passed through the mouth and directed towards the esophagus and stomach. This inflated balloon opens the walls of the veins and stops the bleeding. Another treatment method is endoscopic sclerotherapy.
In this treatment, it is aimed to narrow the swollen esophageal vessels by injecting a mixture into the patient. This method has worked in 90% of patients, but it can lead to esophageal ulcers, more bleeding, or narrowing of the esophagus.
There is a new treatment method called endoscopic ligation, which is the ligation of vessels with flexible rubber bands and is more effective than sclerotherapy.
Application of Endoscopic Band Ligation to Esophageal Varices (EBL)
- It is the method used in the treatment of bleeding from varicose veins in the esophagus.
- With the endoscopy instrument, the esophagus is entered and enlarged veins are searched.
- Usually, red dots or lines are a sign of bleeding.
- Esophageal varices are wrapped with an elastic band so that there is no bleeding. Thus, the blood flow to the varicose is cut off.
- The structure of the varicose, which is wrapped with tape, deteriorates over time, tissue death occurs and spontaneously breaks off from the esophagus.
- Tissue repair fibrosis develops around the vessel where the tape is placed, thus reducing the risk of bleeding from there.
