Results of rubber band ligation of esophageal varices.

BACKGROUND: The aim of the paper is to analyze the results of endoscopic rubber band ligation of esophageal varices performed between 1 January 1998 and 1 November 2000 at the Department of GI Surgery of 4th Military University Hospital.

MATERIAL AND METHODS: Cases of 50 patients with massive upper GI variceal bleeding present on admission or with the history of such a bleeding were reviewed. A total of 85 endoscopic procedures of rubber band ligation were performed. In 9 (18%) cases ligation was performed due to massive variceal bleeding, in 1 case the complementary obliteration of stomach fundus varices with Aethoxysclerol was performed. In 10 (20%) cases in grade C of Child-Pough scale of liver failure, 3 endoscopic procedures were performed, in 15 (30%) in grade B--2 procedures, in the remaining 25 (50%) cases, also in grade B--1 procedure was performed. Procedures were conducted with Wilson-Cook Multi-Band Ligator SAEED SixShooter.

RESULTS: In all cases with non-bleeding esophageal varices the overall good result of treatment was achieved, with collapsing of variceal columns. In 8 (88.8%) of 9 cases treated due to variceal bleeding, good hemostasis was achieved and no reintervention was necessary. In 1 case of massive variceal bleeding endoscopic treatment failed and patient eventually died. In 25 (50%) cases the complementary (1 or 2) rubber band ligations were performed. Follow-up period has ranged from 1 to 34 months. No cases of severe complications after the procedure were noted. In early period after the procedure 43 (86%) patients complained of transient, mild retrosternal pain and mild to moderate dysphagia.

CONCLUSIONS: Endoscopic rubber band ligation is a safe and effective treatment for esophageal varices both in cases of variceal bleeding and as elective procedure.