Surgical Endoscopy

, Volume 3, Issue 2, pp 73–78 | Cite as

Technique and early clinical results of endoscopic variceal ligation (EVL)

  • Greg V. Stiegmann
  • John S. Goff
  • John H. Sun
  • Deborah Davis
  • Dean Silas
Original Articles


Endoscopic variceal ligation (EVL) is a new technique designed to be used instead of sclerotherapy. Small elastic “O” rings ligate varices resulting in their strangulation and eradication. During a 12-month period, EVL was employed in 53 consecutive patients, of whom 36 (68%) had alcoholic cirrhosis 17 were Child-Pugh class A, 22 class B, and 14 class C. Varices were graded from I to IV and repeat treatments were given at 1–2 week intervals until the varices were eliminated. At follow-up ranging from 6–18 months (mean 11.5), 217 EVL treatment sessions had been performed. Of the 13 patients (24%) who died during the study, 11 died during the index hospitalization. Active bleeding was controlled in 19 of 21 patients (90%). Of 40 survivors 13 patients (33%) had 1–2 (mean 1.4) recurrent variceal bleeds while 34 patients had repeat EVL treatment. Elimination of distal varices was achieved in 26 and 7 had reduction of varices from grade III–IV to grade I–II or less. Eradication required a mean of 4.4 EVL sessions in Child's A and B patients and 7.0 sessions in Child's C patients (P<0.025). No significant treatment-related complications were observed. EVL appears to control active bleeding, is associated with a low incidence of non-bleeding complications, and may be used as an alternative to sclerotherapy.

Key words

Esophageal varices Endoscopic ligation Endoscopic sclerotherapy 


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Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • Greg V. Stiegmann
    • 1
  • John S. Goff
    • 2
  • John H. Sun
    • 1
  • Deborah Davis
    • 1
  • Dean Silas
    • 2
  1. 1.Department of Surgery (Gastrointestinal/Tumor)University of Colorado and Denver Veterans HospitalsDenverUSA
  2. 2.Department of Medicine (Gastroenterology)University of Colorado and Denver Veterans HospitalsDenverUSA

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