Endoscopic Treatment for Variceal Bleeding

Treatment Overview

Endoscopic therapy is the method most commonly used to treat active variceal bleeding in the esophagus. Variceal bleeding occurs when pressure increases in the portal vein system and the veins in the esophagus enlarge to help blood flow through the liver. It also may be used to prevent recurrent episodes of variceal bleeding, which are common.

The two forms of endoscopic therapy are:

• Endoscopic variceal banding (also called ligation).
• Endoscopic sclerotherapy.

Endoscopic therapy is usually used along with medicines taken regularly, such as beta-blockers and vasoconstrictors.

Endoscopic variceal banding (or ligation)

During variceal banding, a doctor uses an endoscope to place an elastic ring that looks like a rubber band around an enlarged vein (varice). Banding the vein in this manner will cut off blood flow through the vein. It may be hard to use this procedure while someone is actively bleeding, because the device used to place the bands blocks the doctor's vision.

Variceal banding is often done several times to control the varices and prevent bleeding. For example, banding might be repeated every 2 to 4 weeks for 3 to 4 sessions. Your doctor will check the varices regularly.

Endoscopic sclerotherapy

During endoscopic sclerotherapy, a chemical called a sclerosant is injected directly into an enlarged vein or into the wall of the esophagus next to the enlarged veins. The substance causes inflammation of the inside lining of the vein. Over time this causes the vein to close off and scar. When the vein is closed off, blood cannot flow through it.

Risks

Problems caused by endoscopic treatment are not common. If problems do occur, they may include:

• Infection.
• Puncture of the wall of the esophagus (esophageal perforation).
• Sores in the esophagus (esophageal ulcers).
• Narrowing of the esophagus (esophageal stricture).
• Aspiration pneumonia.