| Rubber band ligature (banding) |
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Placing elastic
O-ring ligatures is an alternative way to treat bleeding
varices.
The procedure is shown in the 3 following pictures.
To the left the spurting
varix is drawn into the sleeve of the banding device (
Six-ShooterŪ ), thereafter
the banding is performed by application of the elastic O-ring.
(Middle).
Multiple (up to six) rings can be deployed from the device
onto the varices by means of release strings without
retraction and reintubation of the
endoscope. The right
picture shows the strangulated varix after ligature. |
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These 3 photos
represent the pathological changes occurring after ligation.
The shows the varice
just after
ligation, whereas the photo in the
middle was taken 1 day after ligation at the instance
of an emergency second look
gastroscopy. The rubber band has already fallen off, leaving
behind an oozing ulcer. Further endoscopic therapy is
mandatory and implemented by applying another rubberband at
amore distal location.
The shows a ligated
cardial varice as shown by inversion of the endoscope in the
stomach.
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Rubberband
found in the stomach after unsuccessful deployment onto
a esophageal varice.
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Ligature