Modified Endoscopic Variceal Ligation

Endoscopic variceal ligation (EVL) has been widely adopted because it is technically easy to perform. However, it is not always possible to eradicate varices by the standard ligation method. Therefore, we examined the effectiveness of the intensive ligation method as an alternative for the eradication of varices. In applying this method, rubber bands are used to make ligations much closer to each other, than with the standard method, just above the esophago-gastric junction (EG-junction). We also compared the effectiveness of EVL in nine cases undergoing the standard ligation method with that in nine cases treated by the new intensive ligation method. With the standard ligation method, the average number of sessions was 2.2 per week, while the average number of rubber bands used was 9.6 per patient. Varices disappeared in three of nine cases. With the intensive ligation method, the number of sessions was two per week in all cases, while the average number of rubber bands was 19.9 per patient. Varices disappeared in all nine cases. Chest discomfort, as a complication, was experienced by three of nine cases in both groups. It is concluded that the intensive ligation method is a very effective means of achieving early, safe eradication of varices.