Endoscopic Treatment for Variceal Bleeding

Endoscopy is the most common procedure used to treat active variceal bleeding in the lower esophagus. Variceal bleeding occurs when blood pressure increases in the portal vein system of the liver. The high pressure causes the veins in the esophagus to swell, and they can rupture and bleed.

Two types of endoscopic treatment that can stop the active bleeding and help prevent future bleeding are:

• Variceal banding (also called ligation).
• Sclerotherapy.

Endoscopic treatment is usually used along with medicines taken regularly, such as beta-blockers and vasoconstrictors.

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 will stop blood flow through the vein. It may be hard to use this procedure while someone has active bleeding, because the bleeding and the device used to place the bands can block the doctor's vision.

Variceal banding is often done several times to prevent the varices from bleeding again. For example, banding might be done every 2 to 4 weeks over a period of 1 to 3 months. Your doctor will check the bands and the varices regularly.

Sclerotherapy

During sclerotherapy, a special chemical is injected directly into an enlarged vein or into the wall of the lower esophagus next to the enlarged vein. The chemical causes the vein to close off and scar, which prevents bleeding.