GI Endoscopy · 1 min read
The Hepatology Interface: Variceal Ligation Protocols
Clinical Bottom Line
| Variceal Bleeding Type | Initial Endoscopic Rescue Modality | Secondary Salvage Technique |
|---|---|---|
| Esophageal Varices | Endoscopic Band Ligation (EBL). | Balloon Tamponade (Sengstaken-Blakemore tube) or fully covered metal stent. |
| Gastric Varices (IGV-1) | Cyanoacrylate (Superglue) Injection. | Endoscopic Ultrasound (EUS) guided coil embolization. |
The Endoscopic Intersection with Cirrhosis
Gastroenterology and Hepatology are inexorably linked by portal hypertension. As the cirrhotic liver becomes violently fibrotic, venous blood routing back from the intestines hits a massive pressure wall (portal hypertension), forcing blood to physically reverse course and balloon into the delicate submucosal veins of the distal esophagus and gastric fundus.
The Ligation Workflow
When an esophageal varix raptures, the mortality rate is staggering. The immediate endoscopic intervention is Endoscopic Band Ligation (EBL). A plastic cap containing small rubber bands is mounted to the end of the gastroscope. Inside the esophagus, the endoscopist physically suctions the bleeding, bulging vein directly into the cap and fires a tripwire, instantly deploying a rubber band around the base of the vein. This mechanically strangulates the varix, causing it to thrombose, necrose, and eventually slough off harmlessly leaving a shallow ulcer.
Clinical guidelines summarized by the Gastroscholar Research Team. Last updated: 2026. This article is intended for physicians.
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