Esophageal banding, formally known as Endoscopic Variceal Ligation (EVL), is a medical procedure used to treat enlarged veins in the lower part of the esophagus. This intervention is performed using an endoscope and serves as a mechanical method to stop or prevent life-threatening bleeding. The primary purpose of this technique is to control hemorrhage from these fragile vessels, known as esophageal varices.
Understanding Esophageal Varices
Esophageal varices are abnormally enlarged and fragile veins located in the lining of the lower esophagus. These vessels develop when the normal flow of blood to the liver is obstructed, typically by advanced liver disease like cirrhosis. The resulting high blood pressure in the portal vein system, called portal hypertension, forces blood to reroute into smaller veins in the esophagus.
Because these rerouted veins were not designed to handle high-volume blood flow, they become distended and prone to rupture. The thin walls of these enlarged varices can lead to rapid and severe internal bleeding. This hemorrhage is a serious complication of advanced liver disease and requires immediate medical intervention.
How the Banding Procedure Works
The ligation procedure utilizes a flexible, lighted endoscope, which is inserted through the patient’s mouth and guided into the esophagus. A specialized device containing several pre-loaded elastic rubber bands is attached to the end of the scope. This device mechanically obliterates the varices.
Once the endoscopist identifies a varix, the device tip is positioned directly over the enlarged vein. Gentle suction is applied, pulling the varix tissue into a small, cylindrical chamber at the end of the scope. The suction creates a small column of tissue inside the chamber.
A trigger mechanism deploys an elastic band, securely wrapping it around the base of the suctioned tissue. This action immediately cuts off the blood supply to the varix. Over the following days, the banded tissue undergoes localized necrosis and sloughs off, leaving a small scar that closes the vein and prevents future bleeding. Multiple varices can be treated during a single session using multi-band ligating devices.
Patient Preparation and Post-Procedure Care
Preparation for esophageal banding involves fasting for eight to twelve hours to ensure the stomach is empty before the procedure. Before the procedure begins, patients receive intravenous sedation to ensure comfort and minimize movement.
Following the procedure, patients are monitored in a recovery area until the sedative effects wear off, usually within one to two hours. Mild to moderate discomfort, such as a sore throat or temporary chest pressure, is common for the first 24 to 48 hours. Patients may use over-the-counter pain relievers for this soreness.
Dietary adjustments are a necessary part of post-procedure care to protect the healing sites. Patients typically begin with clear liquids, gradually advancing to a soft or mushy diet for the next one to seven days. Foods that are sharp, crunchy, or rough in texture are strictly avoided to prevent trauma to the newly banded areas.
Associated Risks and Follow-Up
While endoscopic variceal ligation is generally considered a safe and effective procedure, there are associated risks that require attention. The most serious potential complication is re-bleeding, which can occur from the newly treated site or from other varices. Other possible adverse events include the formation of an esophageal ulcer at the ligation site, which can cause pain, and, rarely, perforation of the esophageal wall.
Some patients may also experience dysphagia, or difficulty swallowing, which can be due to temporary swelling or, in rare cases, the development of an esophageal stricture or narrowing. Because varices often recur, banding is seldom a one-time treatment. Patients must adhere to a strict follow-up schedule involving surveillance endoscopies.
Repeat banding sessions are typically scheduled every two to four weeks until all varices are fully eradicated or stabilized. After successful eradication, ongoing monitoring is necessary, with follow-up endoscopies performed at specific intervals, such as six months, to check for the return of varices. Long-term management often includes medication, such as nonselective beta-blockers, to help reduce the underlying portal pressure and lower the risk of recurrence.