Topic Overview
In people who have
cirrhosis, high pressure in the veins that carry blood
from the intestines to the liver (portal hypertension) causes many problems. Variceal bleeding-bleeding from
enlarged veins (varices) in the digestive tract-is an extremely serious
complication of portal hypertension. For people who have advanced cirrhosis and
varices, especially in the esophagus, the risk of variceal bleeding is high.
After varices have bled the first time, there is a high risk of bleeding again.
The chance of bleeding again is highest right after the first bleed stops. Then
the chance of bleeding again gradually goes down over the next several weeks.
If varices are not treated, bleeding can lead to death.
Endoscopic therapy is the method most commonly used to
treat immediate (acute) variceal bleeding. It also may be used to prevent
recurrent episodes of variceal bleeding, which are common. The two forms of
endoscopic therapy are:
- Endoscopic variceal banding (also called
ligation).
- Endoscopic sclerotherapy.
Endoscopic therapy is usually used along with medicines
such as beta-blockers and vasoconstrictors.
Endoscopic variceal banding (or ligation)
During variceal banding, a doctor uses an endoscope to place an
elastic ring that looks like a rubber band around an enlarged vein. Banding the
vein in this manner will cut off blood flow through the vein. It may be
difficult to use this procedure while someone is actively bleeding, because the
device used to place the bands obscures the doctor's vision.
Variceal banding has been shown to be as effective as sclerotherapy
in treating episodes of bleeding. And it has fewer complications.footnote 1
Variceal banding is often done several times to control the varices
and prevent bleeding. For example, banding might be repeated every 2 to 4 weeks
for 3 to 4 sessions. Your doctor will monitor (check) the varices every 3 to 12
months after that for the rest of your life.
Endoscopic sclerotherapy
During endoscopic sclerotherapy, a chemical called a sclerosant may
be injected directly into an enlarged vein or into the wall of the
esophagus next to the enlarged veins. The substance
causes inflammation of the inside lining of the vein, which over time causes
the vein to close off and scar. When the vein is closed off, blood cannot flow
through it.
Endoscopic sclerotherapy may be effective for stopping immediate
(acute) bleeding caused by esophageal varices.
Sclerotherapy is still done in emergencies, but it is not as
popular as it was in the past. More than before, doctors are using variceal
banding to treat and prevent esophageal variceal bleeding. Even if
sclerotherapy is done at first, variceal banding is usually done later to
prevent future bleeding. Both procedures work. But variceal banding has less
chance of complication than sclerotherapy.
Complications of endoscopic therapy
Complications of endoscopic sclerotherapy are not common. And
complications of variceal banding are even less common. If complications do
occur, they may include:
- Infection.
- Puncture of the wall of
the esophagus (esophageal perforation).
- Sores in the esophagus
(esophageal ulcers).
- Narrowing of the esophagus (esophageal
stricture).
- Aspiration pneumonia.