Clinical Significance of Multi - Band Ligation for Esophageal Variceal Bleeding / 대한소화기내시경학회지

Endoscopic esophageal variceal ligation(EVL) was first introduced by Stiegmann and colleagues in 1986, and it has since grown to he became an extremely popular modality throughout the world as well as Korea. Endoseopic variceal ligation(EVL), which consists of mechanical ligation and thrombosis of varices using elastic O-rings, has been recently developed as a non-operative alternative to endapic injection sclerotherapy(EIS). EVL is minimally operator-dependent and is also associated with fewer local and systemic complications than sclerotherapy. However, the conventional device has only one O ring, and thus the inner cylinder has to be exchanged after each ligation, So, it is a time-consurning procedure that requires the use of an overtube which has somtimes caused tearing of the esophageal mucosa. To save time and control variceal bleeding, multi-band ligation(MBL) was developed. These ligators have five or six O rings, and serial ligation is now possible without exchanging the cylinder or withdrawing the endoscope.(continue...)

Endoscopic Variceal Ligation for Treatment of Esophageal Variceal Bleeding / 대한소화기내시경학회지

Endoscopic variceal ligation(EVL) is newly developed method to manage esophageal variceal bleeding. This study asse initial control rate of active variceal bleeding, incidence of rebleeding and complications in EVL. From June in l992 to December in 1994, this study was performed on 70 patients who had visited to our medical center for melena or hematemesis by acute esophageal variceal bleeding. In all of 70 cases, eradication of esophageal varix was performed and variceal bleeding was controlled well. And first session was performed successfully with EVL. But rebleeding was occured in 12 cases(11 cases caused by esoyhageal varix and 1 case caused by esophageal ulcer) during follow-up period, so EVL therapy was performed repeatedly and 8 cases were eradicated and 4 cases were uncontrolled and died, and then 94% hemostatic effect was achieved during follow-up period. Complications of EVL therapy were mild(substernal discomfort in 12 cases, substernal pain in 4 cases, fever in 3 cases, mild dysphagia in 2 cases) and well controlled. Superficial esaphageal ulcer was shown in 18 cases by follow-up endoscopy after 1 week. These results show that EVL is a good therapeutic method to control active variceal bleeding and eradication of varix with repeat treatment. In conclusion, EVL is an effective and safe method of treatment and prevention for esophageal variceal bleeding.

A Novel Method for Overtube Placement in Endoscopic Variceal Ligation / 대한소화기내시경학회지

Endoscopic variceal ligation (EVL) is effective for the management of bleeding esophageal varices, and its use is widespread now. EVL necessitates the use of overtubes. Two primary techniques have been used for overtube placement; one is with endoscope, and the other is with bougie dilator. Overtube placement with endoseope is not without risk. There are reportd of esophageal or pharyngeal laceration or perforation. Overtube placement with bougie dilator circumvents this risk, but it is rather cumbersome to use. The authors devised a safe and easy method for overtube placement, and applied it to a number of patients to test its safety and convenience. First, overtube-dilator assembly was prepared as follows. A Rigiflex achalasia dilator (balloon 30mm OD, 10cm length; Microvasive Co) was lubricated and inserted into the overtube. A tenth of the balloon tip was protruded out of the overtube, then the balloon was insufflated with air at 10-15 psi. Second, standard endoscopy was performed, followed by placement of guide wire in the stomach. Overtube-dilator assembly was lubricated and introduced over the wire as a rail. Once the overtube was properly positioned, the balloon was deflated, and the balloon and wire were removed as a whole, which completed overtube placement. For 65 patients with esophageal variceal bleeding, 82 procedures of EVL were performed using the new technique. Overtube-dilator assembly was easy to prepare and handle. This technique added little time to the procedure and minimizes patients discomfort. No patient suffered major complications such as bleeding, laceration or perforation. This novel method for overtube placement was safe and convenient for use in EVL. It can also be applied to other procedures using overtube such as endoscopic foreign body removal.