Quick Tips and Tricks for Endoscopic Band Ligation of Esophageal Varices

By

Diana Dougherty, MD (Gastroenterology Fellow) and

Klaus Mönkemüller, MD, PhD, FASGE, FJGES

Professor of Medicine, Virginia Tech Carilion School of Medicine, Virginia, USA; Universidad de la República, Montevideo, Uruguay; University of Belgrade, Belgrade, Serbia, Universidad Espiritu Santo; Ecuador, University of Osijek, Croatia

A 58-year-old patient with cirrhosis (Child-Puch B, MELD 20) presented for EGD for screening esophageal varices. He was found to have large esophageal varices with red spots or markings (Figure 1 A) and four columns of varices (Figure 1B). Figures 1C and 1D show additional examples of red markings or spots (yellow arrows). These red spots are areas of wall thinning that may rupture and result in hemorrhage. The light blue arrow on Figure 1D shows a red marking, but here it is also possible to see some “bumps” or surface irregularity suggestive of significant wall thinning.

The key steps to follow when using band ligation for esophageal varices are: