Skip to main content

Endoscopic Treatment of Esophageal Varices: Endoscopic Variceal Ligation Using a Multi-Band Ligator

  • Chapter
  • First Online:
Clinical Investigation of Portal Hypertension

Abstract

Endoscopic variceal ligation (EVL), a safe and effective treatment for esophageal varices, has undergone rapid progress since its invention. One of the greatest advantages of EVL over endoscopic injection sclerotherapy (EIS) is its versatile adaptability, particularly for high-risk populations such as elderly patients. Originally, the “Stiegmann-Goff Ligator Kit” (Bard Co., USA) used for the EVL procedure was equipped with a wire to remove the ligature bands from the endoscope. In Japan, the modified pneumo-activated EVL device (Sumitomo Bakelite Co. Ltd.) was invented and came into common use. These single-band ligators require an over-tube to ligate esophageal varices. However, we now use a multi-band ligator without an over-tube to perform ligations in rapid succession. This chapter contains an outline description of the multi-band ligator comparing with the single-band ligator.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Fukui H, Saito H, Ueno Y, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol. 2016;51:629–50.

    Article  CAS  Google Scholar 

  2. D’Amico G, Morabito A. Noninvasive markers of esophageal varices: another round, not the last. Hepatology. 2004;39:30–4.

    Article  Google Scholar 

  3. Garcia-Tsao G, Sanyal AJ, Grace ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46:922–38.

    Article  CAS  Google Scholar 

  4. Feu F, García-Pagán JC, Bosch J, et al. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis. Lancet. 1995;346:1056–9.

    Article  CAS  Google Scholar 

  5. D’Amico G, Garcia-Pagan JC, Luca A, et al. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology. 2006;131:1611–24.

    Article  Google Scholar 

  6. Burroughs AK, Triantos CK. Predicting failure to control bleeding and mortality in acute variceal bleeding. J Hepatol. 2008;48:185–8.

    Article  CAS  Google Scholar 

  7. Ideo G, Bellati G, Fesce E, et al. Nadolol can prevent the first gastrointestinal bleeding in cirrhotics: a prospective, randomized study. Hepatology. 1988;8:6–9.

    Article  CAS  Google Scholar 

  8. Garden OJ, Mills PR, Birnie GG, et al. Propranolol in the prevention of recurrent variceal hemorrhage in cirrhotic patients. A controlled trial. Gastroenterology. 1990;98:185–90.

    Article  CAS  Google Scholar 

  9. Schepke M, Kleber G, Nurnberg D, et al. Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology. 2004;40:65–72.

    Article  Google Scholar 

  10. Stiegmann GV, Goff JS, Michaletz Onody PA, et al. Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. N Engl J Med. 1992;326:1527–32.

    Article  CAS  Google Scholar 

  11. Gimson AES, Ramage JK, Panos MZ, et al. Randomized trial of variceal banding ligation versus injection sclerotherapy for bleeding esophageal varices. Lancet. 1993;342:391–4.

    Article  CAS  Google Scholar 

  12. Laine L, El-Newihi HM, Migikovsky B, et al. Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices. Ann Intern Med. 1993;119:1–7.

    Article  CAS  Google Scholar 

  13. Hou MC, Lin HC, Kuo BIT, et al. Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: a prospective randomized trial. Hepatology. 1995;21:1517–22.

    CAS  PubMed  Google Scholar 

  14. Sarin SK, Govil A, Jain AK, et al. Prospective randomized trial of endoscopic sclerotherapy versus variceal band ligation for esophageal varices: influence on gastropathy, gastric varices and variceal recurrence. J Hepatol. 1997;26:826–32.

    Article  CAS  Google Scholar 

  15. Baroncini D, Milandri GL, Borione D, et al. A prospective randomized trial of sclerotherapy versus ligation in the treatment of bleeding esophageal varices. Endoscopy. 1997;29:235–40.

    Article  CAS  Google Scholar 

  16. Takeuchi M, Nakai Y, Sha S, et al. Combined ligation and paravariceal injection sclerotherapy for esophageal varices: outcome over 3 years. Gastroenterol Endosc. 1997;39:1189–95.

    Google Scholar 

  17. Jia Y, Dwivedi A, Elhanafi S, et al. Low risk of bacteremia after endoscopic variceal therapy for esophageal varices: a systematic review and meta-analysis. Endosc Int Open. 2015;03(05):409–17.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yoshiyuki Suzuki .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Suzuki, Y., Murashima, N. (2019). Endoscopic Treatment of Esophageal Varices: Endoscopic Variceal Ligation Using a Multi-Band Ligator. In: Obara, K. (eds) Clinical Investigation of Portal Hypertension. Springer, Singapore. https://doi.org/10.1007/978-981-10-7425-7_28

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-7425-7_28

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-7424-0

  • Online ISBN: 978-981-10-7425-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics