Varices are enlarged veins that can develop in the esophagus, the tube connecting the throat to the stomach. These vessels pose a serious health concern due to their potential to rupture and bleed. Endoscopic variceal ligation, or varices banding, is a procedure used to address this condition. This article explains what varices are, how banding works, and what to expect before, during, and after.
What Are Varices?
Varices are dilated veins, often found in the lower esophagus or upper stomach. They form when blood flow to the liver is obstructed, typically due to scarring, a condition known as cirrhosis. This scarring can be caused by various factors, including hepatitis infections, chronic alcohol use, or fatty liver disease.
The liver receives blood through the portal vein. When scarred, blood flow becomes restricted, leading to increased pressure within the portal vein, called portal hypertension. This elevated pressure forces blood into smaller, fragile veins, which then enlarge into varices. These veins are susceptible to rupture, which can result in significant internal bleeding and is considered a medical emergency.
How Varices Banding Works
Varices banding, or endoscopic variceal ligation (EVL), treats or prevents bleeding from enlarged veins. An endoscope, a flexible tube with a camera and light, is inserted through the mouth into the esophagus to visualize the varices.
Once a varix is identified, a device on the endoscope suctions the vein into a small chamber. A tiny elastic band is then deployed around the vein’s base, strangling it and cutting off its blood supply. Over 5 to 7 days, the banded tissue dies and detaches, leaving a small ulcer that typically heals within weeks. Multiple bands can be placed per session, and the procedure can be repeated until varices are reduced or eliminated.
Before and After the Procedure
Before varices banding, patients receive specific instructions for safety and a clear view during the endoscopy. Fasting for 6 to 8 hours is usually advised, though clear liquids may be permitted up to two hours prior. Current medications are reviewed, and some blood-thinning agents may need to be temporarily stopped. Patients receive intravenous sedation to help them relax and minimize discomfort. A local anesthetic spray may also be applied to the throat to suppress the gag reflex.
Following banding, patients are moved to a recovery area for monitoring as sedation wears off. A sore throat or mild chest discomfort is common for a day or two. Patients are advised not to eat or drink for about two hours. After this, starting with clear liquids and then progressing to soft foods for the remainder of the day is recommended. Strenuous activities should be avoided for 24 hours, and driving is not permitted until sedation effects subside.
What to Expect Post-Banding
After returning home, patients should follow dietary guidelines, often including soft foods for up to a week to aid healing. While a single banding session can be effective, many require multiple sessions, typically spaced every two to four weeks, to address existing varices. The goal is to reduce varices and minimize future bleeding risk.
Regular follow-up endoscopies are usually scheduled every 6 to 12 months to monitor for recurrence. Seek immediate medical attention for symptoms like vomiting bright red blood, severe chest pain that does not subside, or passing black, tarry stools. These signs could indicate new bleeding and require prompt evaluation.