Esophageal banding is a medical procedure that involves placing small elastic bands around enlarged veins within the esophagus, the tube connecting the mouth to the stomach. Its primary purpose is to prevent or stop bleeding from these vulnerable blood vessels.
Understanding Esophageal Varices
Esophageal varices are swollen, fragile veins in the lower esophagus. These abnormal veins develop due to elevated blood pressure within the portal vein system, a condition known as portal hypertension. The portal vein transports blood from digestive organs to the liver. When blood flow through the liver is obstructed, often by scar tissue from severe liver disease like cirrhosis, pressure increases. This forces blood to reroute through smaller, more delicate veins, including those in the esophagus, causing them to enlarge and become susceptible to rupture.
Varices do not cause symptoms unless they bleed. Bleeding can manifest as vomiting large amounts of blood or passing black, tarry stools, indicating digested blood. This bleeding can be sudden and severe, leading to lightheadedness, weakness, and even loss of consciousness. The risk of bleeding increases with higher portal vein pressure and varix size.
The Procedure Explained
Esophageal banding, also known as endoscopic variceal ligation, uses a flexible endoscope, a thin tube with a camera and light, to visualize the esophagus. A specialized band ligator device, pre-loaded with elastic bands, attaches to the end of the endoscope. Once a gastroenterologist identifies an enlarged esophageal varix, it is gently suctioned into a chamber at the end of the ligator.
An elastic band is then deployed, encircling the base of the suctioned varix. This action cuts off its blood supply. Over the subsequent days to weeks, the banded tissue necroses, or dies, and then sloughs off. This process leaves behind scar tissue, which helps to obliterate the varix and reduce the risk of future bleeding. Multiple bands can be applied during a single procedure, performed on an outpatient basis.
Before and After the Procedure
Preparation for esophageal banding involves specific guidelines. Patients fast for a certain period before the procedure, often abstaining from food and drink for several hours. Medication adjustments, particularly for blood thinners, may be necessary and should be discussed with the healthcare provider.
Following the procedure, patients are monitored in a recovery area until sedation effects wear off. Common sensations include a sore throat and mild chest discomfort, which subside within 24 to 48 hours.
To facilitate healing and minimize irritation, a modified diet is recommended. Patients start with clear liquids for a few hours, gradually advancing to soft, bland foods like puddings, soup, mashed potatoes, and yogurt for about a week. Avoiding hard, spicy, or acidic foods, as well as alcohol, is advised. Follow-up appointments are needed, as repeat banding sessions every two to four weeks may be necessary to eliminate varices or prevent re-bleeding.
Potential Considerations
While esophageal banding is a safe procedure, side effects and complications can occur. Mild and temporary side effects include discomfort, such as a sore throat, difficulty swallowing, or mild chest pain. Bloating and stomach cramps are also possible due to air introduced during the endoscopy.
More serious, though less common, complications can include re-bleeding from the banded site, which can occur if the band dislodges prematurely or if new varices form. Esophageal perforation, a rare but severe complication involving a tear in the esophageal wall, can also occur. Additionally, esophageal stricture, a narrowing of the esophagus due to scar tissue, or esophageal ulcers at the banding site are possibilities. Patients should seek immediate medical attention for symptoms such as severe chest pain, persistent difficulty swallowing, significant bleeding, or fever.