A procedure in which small elastic bands are placed on varicose veins in the esophagus with endoscopic guidance to stop or prevent bleeding. It is the most commonly used treatment in patients with liver cirrhosis.
Indication
- Bleeding esophageal varices — for emergency hemostasis
- Prevention of recurrence in varices that have bled previously (secondary prophylaxis)
- Preventive treatment of large varices at high risk of bleeding (primary prophylaxis)
- Varices due to portal hypertension related to liver cirrhosis
- Patients who do not respond to or cannot tolerate beta-blocker therapy
- Selected cases of gastric fundus varices (with a special banding technique)
Preparation
- No food or drink for 8 hours before the procedure (except in emergency cases)
- Blood thinners (warfarin, clopidogrel) are adjusted with the physician's approval
- Evaluation with hemoglobin, platelet, and INR blood tests
- Intravenous access is established and blood products are kept ready if needed
- In active bleeding, intravenous fluids, antibiotics, and vasoactive medications are started
How it's performed
- Sedation is administered through the IV line, and vital signs are continuously monitored
- The endoscope is passed into the esophagus with a band device attached to its tip
- The varix is suctioned at the tip of the endoscope, forming a small mound
- An elastic band is released over it; the band strangulates the vessel and cuts off blood flow
- Generally 4–8 bands are placed on all visible large varices in the same session
- After the procedure, it is checked that there is no bleeding or remaining new varices
Post-procedure
- Observation for 1–2 hours after the procedure; 24-hour admission in cases of active bleeding
- First day: cool-warm liquids and soft food; avoiding hard and hot foods
- Banding is generally repeated at 2–4 week intervals until the varices are fully obliterated
- Surveillance endoscopy at 6–12 month intervals after treatment is completed
- Beta-blocker therapy (propranolol/nadolol) is added in most patients
Risks
- Transient chest pain, swallowing difficulty, and throat irritation (common, lasting a few days)
- Ulcer bleeding after the band falls off (2–5%)
- Esophageal stricture (rare, with repeated banding)
- Risk of bacteremia and infection; antibiotic prophylaxis is given to cirrhotic patients
- Cardiorespiratory side effects related to sedation (rare)
FAQ
Is the procedure painful?
Because it is performed under sedation, no pain is felt during the procedure. Afterwards, there may be mild discomfort with swallowing and a sensation of pressure in the chest for 1–3 days.
Are all varices treated in a single session?
Generally no. To completely obliterate the varices, 3–5 sessions at 2–4 week intervals may be required. New varices are monitored with follow-up endoscopies.
How long does the band stay in place?
The elastic band strangulates the vessel within 5–10 days, causing the tissue to slough off and detach spontaneously; it is then passed in the stool. It does not need to be removed.
Can it bleed again?
When banding is performed alone, the risk of rebleeding within the first year is around 20–30%; adding a beta-blocker significantly reduces this risk.
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