Band Ligation for Esophageal Varices

Esophageal varices are abnormal, enlarged veins in the esophagus. This condition occurs most often in people with advanced liver disease such as cirrhosis.

Cirrhosis causes scar tissue to form in the liver, which slows the flow of blood to the liver. When this happens, pressure in the portal vein – the blood vessel that carries blood from several gastrointestinal organs to the liver – goes up. This high blood pressure in the portal vein, or portal hypertension, causes nearby veins to swell, including those in the esophagus. If the blood pressure gets too high, varices can rupture and bleed, which is a life-threatening emergency that requires immediate treatment.

Esophageal varices are unlikely to cause symptoms unless they have ruptured. If there is only a small amount of bleeding, the only symptom may be black, tarry stools. When severe bleeding occurs, a person will feel dizzy, vomit large amounts of blood, and may lose consciousness.

Those with advanced liver disease should be screened regularly for esophageal varices. Screening is done through an upper endoscopy. The primary goal of band ligation, an endoscopic treatment for esophageal varices, is to prevent the varices from bleeding or stop acute bleeding as soon as possible.

How to Prepare for Band Ligation

You should not eat or drink anything after midnight prior to the procedure. Your doctor will let you know if or when you should adjust or stop any medications you take. Because you will be sedated, you will need someone to drive you home after the procedure.

What to Expect

Band ligation is performed during an upper endoscopy.  You will lie on your left side and receive sedation through an IV line to relax you and make you feel drowsy. A mouth guard will be placed to protect your teeth and gums. Your throat may also be numbed with a spray to calm the gag reflex. Your doctor will insert the endoscope through your mouth and into your esophagus.

The doctor will insert a special instrument through the scope to tie off the varices with tiny elastic bands. This cuts off the blood flow and prevents the varices from bleeding or stops any bleeding that may be occurring. Band ligation can be performed on as many veins as necessary and may be repeated every 4 weeks until the varices have stopped bleeding.

After the bleeding is controlled, the doctor may prescribe medications to reduce blood pressure in the portal vein and prevent bleeding from starting again. An upper endoscopy should be repeated every 6 to 12 months to ensure no varices have reoccurred.