Treatment Overview

Endoscopic therapy is the method most commonly used to treat immediate (acute) variceal bleeding in the esophagus. Variceal bleeding occurs when blood pressure increases in the portal vein system and the veins in the esophagus enlarge to accommodate blocked blood flow through the liver. 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 (varice). Banding the vein in this manner will cut off blood flow through the vein. It may be hard to use this procedure while someone is actively bleeding, because the device used to place the bands blocks 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. Over time this 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 leading to problems than sclerotherapy.

Risks

Problems, or complications, from endoscopic sclerotherapy aren't common. And complications of variceal banding are even less common. If problems 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.