Endoscopic ligation of esophageal varices with rubber ring

This is an automatically translated article.

The article is expertly consulted by Gastroenterologist, Department of Examination & Internal Medicine - Vinmec Hai Phong International General Hospital.
Esophageal varices are a common complication in patients with cirrhosis. This is a rather dangerous disease because of the high risk of bleeding. Endoscopic esophageal sphincter was born after sclerotherapy and is now more popular.

1. What is endoscopic rubber band ligation of the esophagus?

Esophageal vein ligation with rubber ring is a method through endoscopic gastroscopy that uses a rubber ring to tighten varicose veins, causing blood to no longer circulate in the ruptured vein and stop, leading to blood formation. venous mass and fibrosis. The aim is to stop bleeding from the dilated esophageal veins in cirrhosis. The technique is performed through endoscopic interventional esophagitis - stomach.

2. Indications for endoscopic ligation of varicose veins of the esophagus

Ligation for emergency treatment when bleeding due to rupture of esophageal varices. Prophylactic ligation: Recurrent bleeding and primary prevention (Contraindicated with beta-blocker or beta-adrenoceptor-cannot or dilated bunions at risk of rupture)

3. Contraindications for endoscopic ligation of esophageal varices

Cardiovascular collapse, respiratory failure. Intestinal perforation, esophageal fistula, peritonitis. Hepatic coma Accompanied by varicose veins of the stomach and stomach Injuries to the cervical vertebrae. Without parental consent or legal guardian Relative contraindications:
New gastrointestinal surgery 1 month, intestinal obstruction. Coagulopathy (INR > 2), thrombocytopenia (< 50 G/l).

4. Preparation before endoscopic esophageal varices

Patients need to inform the doctor about cardiovascular disease, hematology or taking anticoagulants, allergic conditions (if any).
Patients need to fast for at least 6-8 hours before the procedure.
The patient is under general anesthesia during the procedure.

5. Procedure for endoscopic esophageal varices

Endotracheal anesthesia (prevention of aspiration syndrome). Perform upper gastrointestinal endoscopy to grade the degree of esophageal varices, look for signs of vein rupture, and associated lesions causing bleeding.
The doctor inserts an endoscope through the patient's mouth into the esophagus. A device with rubber bands is inserted to ligate the varicose veins to prevent bleeding. Place the endoscope attached with the gun close to the varicose vein. Slowly suck the varicose veins into the plastic ring, shoot the rubber ring out to tighten the varicose veins, then find another varicose vein that needs ligation.
The esophageal varices are re-examined after 2 weeks to evaluate the effectiveness, if the varicose veins are still dilated, there is a risk of bleeding, the patient will be ligated again.

6. Complications may be encountered during endoscopic intervention

Some possible complications during and after esophageal varices include: chest pain, painful swallowing, nausea and vomiting, bleeding (vomiting blood or passing black stools), infection at the site of ligation.
Due to the effect of anesthesia, the patient should not operate machinery, drive at least 24 hours after endoscopic esophageal varices. After ligation, the patient lies under observation for 24 hours and eats soft and liquid foods for 24 hours.

7. Accident management

Bleeding at the bunion: blood transfusion combined with medication. Pain behind the sternum, difficulty swallowing: eat liquids, take pain relievers. Esophageal ulcer: take medication to reduce acid secretion. Fever: take antibiotics. Vinmec International General Hospital is equipped with the most modern gastrointestinal endoscopy system of Olympus. This is one of the best machine manufacturers in the world. In addition, in subjects with poor cooperation ability, endoscopy under anesthesia will help reduce some of the discomfort and fear when performing endoscopy. From there, the doctor will have better conditions to observe the lesions and perform the most effective intervention for the patient.

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