Oesophageal variceal band ligation

Oesophageal varices are dilated veins in the wall of the oesophagus. They most often appear with cirrhosis of the liver, when blood flows poorly through the liver and pressure rises in the portal vein (portal hypertension). These varices can rupture and cause serious gastrointestinal bleeding. Band ligation is the reference endoscopic treatment. Under sedation or anaesthesia, an endoscope fitted with a small cap is passed through the mouth. Each varix is suctioned into the cap, then an elastic band is placed at its base. The strangled varix breaks down and heals within a few days. Several bands are placed at each session. Ligation is used as an emergency to stop bleeding, or as a planned procedure to prevent a first bleed or a recurrence. Several sessions, a few weeks apart, are usually needed until the varices have disappeared, followed by endoscopic surveillance. It is combined with medical treatment of the liver disease, often a beta-blocker medicine. At Clinique Pasteur Tunis, oesophageal variceal band ligation is performed in the endoscopy suite by a gastroenterologist, with the support of the emergency department and intensive care in the event of bleeding.