Rubber band ligation (varices)
The rubber band ligation is a treatment method for bleeding from dilated veins ( varicose veins , esophageal varices ) of the esophagus (esophagus). It is an alternative to variceal obliteration .
indication
Emergency treatment of life-threatening bleeding from esophageal varices .
technology
During the ligature , up to ten rubber bands are attached to the tip of a gastroscope via a transparent cover :
The esophageal varices are sucked into the sheath and then the rubber ring is stripped over it. This leads to a polyp-like strangulation of the varices . After a few days, the "polyp" falls off and a scar develops in the esophageal wall, which causes the varices to close permanently. Several cords of varices are treated in one endoscopic session in order to achieve a complete ligature. Sometimes the remaining varices must be ligated in a second session.
Complications
After the constricted varices fall off, an ulcer develops , which creates a scar in the esophageal wall. This scar is intended to prevent recanalization (reopening) of the varices. In contrast to the sclerotherapy methods, however, the scars are much flatter. When the ulcer develops, there may be a slight bleeding that can be treated endoscopically.
Bleeding prophylaxis
Despite alternative treatment options (e.g. endoscopic sclerotherapy ), this procedure is the treatment of choice. Whether prophylactic treatment of esophageal varices without prior bleeding is still a matter of debate is still being discussed.
literature
- H. Greten, S. Jäckle, F. Thonke, N. Soehendra: Endoscopic therapy for varicose gastrointestinal bleeding. Dtsch Arztebl 2001; 98 (10): A-608 / B-495 / C-467
- E. Biecker, J. Heller, V. Schmitz, F. Lammert, T. Sauerbruch: Diagnosis and therapy of upper gastrointestinal bleeding. Dtsch Arztebl 2008; 105 (5): 85-93
