What is endoscopic treatment for variceal bleeding?

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.

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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.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
• Allow your body to heal. Don't move quickly or lift anything heavy until you are feeling better.
• You may need to take a day or two off work. It depends on the type of work you do and how you feel.
• For your safety, do not drive or operate any machinery that could be dangerous. Wait until the medicine wears off and you can think clearly and react easily.
• Your doctor may suggest sleeping with more pillows under your head and shoulders so you aren't lying flat.

Diet

• Do not eat or drink for 2 hours after your procedure.
• Drink plenty of fluids (unless your doctor has told you not to).
• Try just liquids for your first meal after the surgery. Then you can have regular food if it feels okay. You might try soft foods until your throat feels better.
• Do not drink alcohol. It increases your risk of bleeding. It can also make liver damage worse. Tell your doctor if you need help to quit. Counseling, support groups, and sometimes medicines can help you stay sober.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You also will be given instructions about taking any new medicines.

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.

Your doctor used a lighted tube (endoscope, or scope) to help fix one or more enlarged veins in your esophagus. That's the tube that carries food from your mouth to your stomach. The enlarged veins are called varices.

The doctor placed elastic rings around the veins. The rings look like rubber bands.

The bands cut off blood flow through the vein. They help prevent internal bleeding.

You may need to have the procedure several times to control the varices and prevent bleeding. Your doctor will check the varices regularly.