Use of detachable snares and elastic bands for endoscopic control of bleeding from large gastric varices.
BACKGROUND
Bleeding from gastric varices larger than 2 cm in diameter represents a major limitation for endoscopic hemostasis.


METHODS
Endoscopic ligation of gastric varices was performed with detachable snares and elastic bands in 41 patients who had recent bleeding from gastric varices larger than 2 cm in diameter. Gastric varices larger than 2 cm were ligated with detachable snares, and then adjacent small gastric varices were ligated with elastic bands.


RESULTS
Among the 41 patients, 10 of 12 patients with active bleeding and 28 of 29 patients with red color signs at initial endoscopy were successfully treated by endoscopic ligation by using detachable snares and elastic bands. Bleeding recurred early (before variceal eradication) in 4 of 38 patients (10.5%). The overall hemostatic rate for endoscopic ligation was 82.9% (34/41). In 33 of 36 patients (91.7%) who underwent repeated ligation treatments, variceal eradication was nearly complete. Mean follow-up in 30 of 33 patients after eradication of varices was 16.4 months (3-32 months), and 29 of 30 did not have recurrent bleeding. During and after ligation there were no serious complications.


CONCLUSIONS
Endoscopic ligation therapy with large detachable snares and elastic bands is safe and effective for treatment of large bleeding gastric varices.
Lee
Moon Sung
MS
Department of Internal Medicine, Institute for Digestive Research, Soon Chun Hyang University, College of Medicine, Seoul, Korea.
Cho
Joo Young
JY
Cheon
Young Koog
YK
Ryu
Chang Beom
CB
Moon
Jong Ho
JH
Cho
Young Deok
YD
Kim
Jin Oh
JO
Kim
Yun Soo
YS
Lee
Joon Seong
JS
Shim
Chan Sup
CS
D000208:Acute Disease; D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence