☎ 0261-2782020 / 2792020 / Mo. No. 90333 62020

Endoscopic variceal ligation (EVL)

Endoscopic variceal ligation (EVL) is a procedure used to treat esophageal varices, which are enlarged veins in the esophagus caused by portal hypertension, often due to liver cirrhosis.

The procedure involves placing rubber bands around the varices to cut off blood flow, causing them to shrink and eventually slough off.

Indications :-

  • Acute Esophageal Variceal Bleeding (Active or Recent Bleed)

    • First-line treatment for acute variceal hemorrhage along with resuscitation and vasoactive drugs (e.g., octreotide, terlipressin).

  • Prophylactic Treatment (Primary Prevention)

    • In patients with high-risk varices (large size, red wale marks, or Child-Pugh B/C cirrhosis).
    • Alternative to nonselective beta-blockers (e.g., propranolol, nadolol) if contraindicated.

  • Prevention of Rebleeding (Secondary Prophylaxis)

    • Combined with beta-blockers to reduce the risk of recurrent bleeding.
  •  

Procedure Steps

  • Preparation:

    • Patient is fasted (usually 6–8 hours before the procedure).
    • Sedation or general anesthesia is used.
    • A flexible endoscope with a variceal ligator is inserted through the mouth.

  • Ligation Process:

    • The endoscope identifies the bleeding or high-risk varices.
    • A suction device pulls the varix into a small chamber.
    • A rubber band is deployed around the varix, occluding blood flow.
    • Multiple bands can be placed in a single session (usually 4–6 bands per session).

  • Post-Procedure Care:

    • Patients are observed for complications such as pain, ulceration, or rebleeding.
    • Soft diet is recommended for a few days.
    • Repeat EVL sessions are scheduled every 2–4 weeks until the varices are eradicated.

Complications of EVL

    • Post-banding ulceration (common, may cause mild pain or bleeding).
    • Dysphagia or Odynophagia (difficulty or pain in swallowing).
    • Early rebleeding (due to incomplete varix eradication).
    • Esophageal perforation (rare but serious).

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