[Endoscopic ligature of esophageal varices in the treatment of portal hypertension].
Endoscopic ligation (EBL) has shown to have greater effectiveness and minor number of adverse side effects than sclerotherapy in the treatment of esophageal varices. The introduction of multiband devices that allow 5-10 bands positioning in a single session, has obtained to simplify the technique execution, avoiding the use of overtube and inherent complications. EBL sessions are carried out every 2 weeks until eradicate the varices, which is obtained in around 90% of the patients after 2-4 sessions. In agreement with the present evidence, non-selective betablockers are the first therapeutic election in primary prophylaxis of hemorrhage by esophageal varices, whereas EBL would have to reserve for patients with betablockers intolerance or contraindications. Combined treatment with betablockers and isosorbide-5-mononitrate, with EBL is probably a good therapeutic option for the secondary prophylaxis of hemorrhage by varices. EBL effectiveness can be increased if it is combined with betablockers. Patients who have contraindications for betablockers treatment or present hemorrhage while receiving prophylaxis with them, must be treated with endoscopic ligation. EBL in combination with vasoactive pharmacological treatment is the election treatment of acute hemorrhage by esophageal varices; nevertheless varices sclerotherapy can be made if the execution of EBL is technically difficult.
Laboratorio de Hemodinámica Hepática, Institut de Malalties Digestives i Métaboliques, Hospital Clínic, IDIBABS, Ciberrehd Barcelona, Spain. JCGARCIA@clinic.ub.es
Juan Carlos
JC
García-Pagán
Pablo
P
Bellot García
Jaime
J
Bosch Genover
D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D004945:Esophagoscopy; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000628:therapy*; D008026:Ligation