title: Cost saving by reloading the multiband ligator in endoscopic esophageal variceal ligation: a proposal for developing countries.
abstract: OBJECTIVE
  To assess the cost savings of reloading the multiband ligator in endoscopic esophageal variceal ligation (EVL) used on the same patient for subsequent sessions.
  
  
  METHODS
  This single centre retrospective descriptive study analysed patients undergoing variceal ligation at a tertiary care centre between 1st January, 2003 and 30th June, 2006. The multiband ligator was reloaded with six hemorrhoidal bands using hemorrhoidal ligator for the second and subsequent sessions. Analysis of cost saving was done for the number of follow-up sessions for the variceal eradication.
  
  
  RESULTS
  A total of 261 patients underwent at least one session of endoscopic esophageal variceal ligation between January 2003 and June 2006. Out of 261, 108 patients (males 67) agreed to follow the eradication program and underwent repeated sessions. A total of 304 sessions was performed with 2.81 sessions per patient on average. Thirty-two patients could not complete the program. In 76 patients (70%), variceal obliteration was achieved. The ratio of the costs for the session with reloaded ligator versus a session with a new ligator was 1:2.37. Among the patients who completed esophageal varices eradication, cost saving with reloaded ligator was 58%.
  
  
  CONCLUSIONS
  EVL using reloaded multiband ligators for the follow-up sessions on patients undergoing variceal eradication is a cost saving procedure. Reloading the ligator thus is recommended especially for developing countries where most of the patients are not health insured.
authors.affiliation: Department of Medicine, The Aga Khan University Hospital Stadium Road, Karachi 74800, Pakistan. zaigham@akunet.o
authors.forename: Zaigham
authors.initials: Z
authors.lastname: Abbas
authors.forename: Lubna
authors.initials: L
authors.lastname: Rizvi
authors.forename: Umair-Syed
authors.initials: US
authors.lastname: Ahmed
authors.forename: Khalid
authors.initials: K
authors.lastname: Mumtaz
authors.forename: Wasim
authors.initials: W
authors.lastname: Jafri
mesh_terms: D003362:Cost-Benefit Analysis; D003906:Developing Countries; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D020701:Esophagoscopes; D004945:Esophagoscopy / Q000191:economics / Q000379:methods*; D005260:Female; D005762:Gastroenterology / Q000191:economics* / Q000379:methods*; D016558:Hemostasis, Endoscopic / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008026:Ligation / Q000295:instrumentation / Q000379:methods; D008297:Male; D011634:Public Health; D012189:Retrospective Studies