Variceal Banding

Variceal banding is one method of treatment for esophageal varices that are at risk for rupturing. This concept was based on years of experience treating hemorrhoids with rubber band ligation and works in a similar way. Your doctor will use a lighted endoscope and place an elastic band around the bleeding esophageal vein. Banding the vein will cut off blood flow through the vein. The banded tissue develops into a small ulceration that quickly heals after several days or a few weeks. This procedure is safe, it does not damage the esophageal wall, and it does not increase pressure in the portal system. Variceal banding may be difficult to perform if a vein is actively bleeding because the endoscope obscures your doctor’s vision.

Variceal banding can be done several times to control enlarged varices and prevent bleeding. Your doctor may recommend repeated banding every two to four weeks for three or four sessions. Banded varices require monitoring, so you will need to schedule visits to your doctor anywhere from one to four times per year.

The Day before the Procedure

You should a light meal for dinner. After your meal, do not eat or drink after midnight. You may be asked to have some blood work done before the procedure such as a Complete Blood Count and/or a Coagulation Profile. You should plan to have someone drive you to and from your procedure because you will be sedated and your faculties will be impaired.

The Day of the Procedure

When you arrive at the surgery center, you will be given medication through an IV to relax you. As you lie on your left side, a supportive device will be placed in your mouth and a suction tube will be used to clear fluids. Your doctor will place a scope into your mouth and down your esophagus. Once the varices have been located, the scope will be removed and the banding device will be attached to the end of the scope. Your doctor will insert the scope back into the esophagus and suck the enlarged vein into the device chamber to band it.

After the Procedure

You will be taken into a recovery area for monitoring as your sedative wears off. For four hours after your procedure, you should only consume clear liquids. After four hours, you may eat soft foods for the remainder of the day. Some people may experience mild to moderate chest pain after variceal banding. If you experience severe chest pain, call your doctor.

It is possible that the bleeding may return even after variceal banding. In fact, most people who have bleeding esophageal varices will experience recurrent bleeding. Further variceal banding and the prescribing of medication called beta blockers may be necessary to prevent re-bleeding.

Risks Associated with Variceal Banding

There are a few possible complications after variceal banding such as:

• Infection
• Return of bleeding
• Puncture of the wall of the esophagus (esophageal perforation)
• Sores in the esophagus (esophageal ulcers)
• Narrowing of the esophagus (esophageal stricture)