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Canadian Journal of Gastroenterology
Volume 6, Issue 4, Pages 213-217

Endoscopic Variceal Ligation for Treatment of Bleeding Varices

John S Goff

University of Colorado Health Sciences Center and Denver Veterans Administration Medical Center, Denver, Colorado, USA

Copyright © 1992 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Endoscopic variceal ligation (EVL) was developed as an alternative to endoscopic variceal sclerosis (ES) because of the latter's high complication rate. The new technique involves placement of small elastic bands around the variceal channels in the distal esophagus. Initial open trials with EVL showed that it was safe and effective therapy for bleeding esophageal varices. EVL can be used emergently to control actively hemorrhaging varices and electively to eradicate varices with repeated sessions. When compareJ directly with results obtained with ES retrospectively and prospectively, EVL is equal or superior in preventing rebleeding while causing many fewer complications. Combining the two techniques may be even more effective than either alone at eradicating varices. Combination therapy has achieved eradication of varices in an average of three sessions, which is one to three fewer sessions than generally reported to achieve eradication with EVL or ES alone. Combination therapy has also been used to control bleeding gastric varices effectively. EVL, alone or with low dose ES, seems to be the safest and most effective endoscopic means for controlling bleeding from esophageal or gastric varices. EVL needs to be evaluated for prophylactic treatment of esophageal varices since its low morbidity profile may make it more suitable than ES for prophylactic treatment.