Endoscopic Treatment of Esophageal Varices: Combination of Endoscopic Variceal Ligation and Endoscopic Injection Sclerotherapy
Endoscopic variceal ligation (EVL) was developed by Stiegmann et al. and has been performed using a device that allows aspiration and ligation of varices using rubber bands (O-rings). The advantage of this mechanical therapy rests on elimination of the need for injection of the sclerosant or tissue glues and, hence, obviation of many complications known to be associated with injection therapies. EVL was introduced to Japan by the authors in 1989, and thereafter, it became the first-line procedure especially for acute variceal bleeding.
On the other hand, in our initial experience of EVL in 1989, 20 out of 23 patients with esophageal varices showed an eradication effect as high as 86.9%; however, complete eradication (F0) could only be observed in five patients (21.7%). To obtain better results, we then performed additional endoscopic injection sclerotherapy (EIS) using 1% polidocanol, which resulted in a 100% eradication effect with 43.5% complete eradication.
We perform EVL/EIS combined therapy for the prevention of variceal bleeding, and for acute bleeding cases, we have found EVL to be superior to other hemostatic options.
In this chapter, we introduce the historic aspect of EVL as well as our technical improvements including the development of an original device.
KeywordsEVL EIS Polidocanol Esophageal varices Endoscopic treatment
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