Therapeutic Procedures

Variceal Banding

Endoscopic band ligation is the use of elastic bands to treat the varices. It is also known as Endoscopicvariceal ligation (EVL). It was developed in an effort to find an effective means of treating esophageal varicesendoscopically with fewer complications than endoscopic sclerotherapy (ES).The concept was based upon many years of experience treating hemorrhoids with rubber band ligation in patients with and without portal hypertension. EVL works by capturing all or part of a varix resulting in occlusion from thrombosis. The tissue then necroses and sloughs off in a few days to weeks, leaving a superficial mucosal ulceration, which rapidly heals.EVL avoids the use of sclerosant and thus eliminates the deep damage to the esophageal wall that occurs after ES.Another interesting finding is that during acute variceal bleeding, the hepatic venous pressure gradient (which correlates with the risk of variceal bleeding) increases after ES, but not after EVL.
Endoscopic variceal ligating devices are placed on the tip of standard endoscopes. The device has a soft sheath portion that fits over the tip of the endoscope and a hard plastic portion. Bands are stretched over the hard portion at the distal end of the device and later deployed onto the varices.

Sclerotherapy

Sclerotherapy for esophageal varices(also called endoscopic sclerotherapy) is a treatment for esophageal bleeding that involves the use of an endoscope and the injection of a sclerosing solution into veins.

Various sclerosing agents are sodium morrhuate, sodium tetradecyl sulfate, and hypertonic saline or glucose.

Sclerotherapy for esophageal varices involves injecting a strong and irritating solution (a sclerosant) into the veins and/or the area beside the distended vein. The sclerosant injected into the vein causes blood clots to form and stops the bleeding. The sclerosant injected into the area beside the distended vein stops the bleeding by thickening and swelling the vein to compress the blood vessel.

Most physicians inject the sclerosant directly into the vein, although injections into the vein and the surrounding area are both effective.

Once bleeding has been stopped, the treatment can be used to significantly reduce or destroy the varices.

Polypectomy

Polypectomy is the medical term for removing Polyps. Colonic polyps are abnormal like growths that protrude into the lining of the bowel. Small polyps can be removed by an instrument called a biopsy forceps, which snips off small pieces of tissue. Larger polyps are usually removed by putting a noose, or snare, around the polyp base and burning through the tissue with electric cautery. Neither of these procedures is painful,and you will usually not be aware that they are being done. Rarely will a polyp be too large to remove by colonoscopy and require surgery for removal.