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Endoscopic band ligation in the treatment of portal hypertension

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 526–535 (2005)Cite this article

Abstract

The evidence that endoscopic band ligation (EBL) has greater efficacy and fewer side effects than endoscopic injection sclerotherapy has renewed interest in endoscopic treatments for portal hypertension. The introduction of multishot band devices, which allow the placement of 5–10 bands at a time, has made the technique much easier to perform, avoiding the use of overtubes and their related complications. EBL sessions are usually repeated at 2 week intervals until varices are obliterated, which is achieved in about 90% of patients after 2–4 sessions. Variceal recurrence is frequent, with 20–75% of patients requiring repeated EBL sessions. According to current evidence, nonselective β-blockers are the preferred treatment option for prevention of a first variceal bleed, whereas EBL should be reserved for patients with contraindications or intolerance to β-blockers. Nonselective β-blockers, probably in association with the vasodilator isosorbide mononitrate, and EBL are good treatment options to prevent recurrent variceal rebleeding. The efficacy of EBL might be increased by combining it with β-blocker therapy. Patients who are intolerant, have contraindications or bled while receiving primary prophylaxis with β-blockers must be treated with EBL. In the latter situation, EBL should be added to rather than replace β-blocker therapy. EBL, in combination with vasoactive drugs, is the recommended form of therapy for acute esophageal variceal bleeding; however, endoscopic injection sclerotherapy can be used in the acute setting if EBL is technically difficult.

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Figure 1: Rubber band (arrow) placed over a varix.
Figure 2: Impact of treatment on the incidence of first variceal bleeding.
Figure 3: Impact of treatment on mortality rates.
Figure 4: Endoscopic therapy in acute variceal bleeding.
Figure 5: Proposed management algorithms for variceal bleeding.

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Acknowledgements

This study was supported by grants from the Ministerio de Educación y Ciencia (SAF 04/04783) and from the Fondo de Investigaciones Sanitarias (FIS 04/0655) and a grant by Instituto de Salud Carlos III (C03/02).

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Authors and Affiliations

  1. Consultant Hepatologist,

    Juan Carlos Garcia-Pagán & Jaime Bosch

  2. Professor of Medicine and Senior Consultant Hepatologist at the Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, University of Barcelona, Spain

    Juan Carlos Garcia-Pagán & Jaime Bosch

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Correspondence to Juan Carlos Garcia-Pagán.

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Garcia-Pagán, J., Bosch, J. Endoscopic band ligation in the treatment of portal hypertension. Nat Rev Gastroenterol Hepatol 2, 526–535 (2005). https://doi.org/10.1038/ncpgasthep0323

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