ADAPTATING ENDOSCOPIC VARICEAL LIGATION USING NUMEROUS O-RINGS FOR ESOPHAGEAL VARICES

Abstract

Adaptating endoscopic variceal ligation using numerous O-rings for esophageal varices (eradicative EVL:eEVL) was performed on 10 patients for the eradication of esophageal varices. The efficasy of eEVL was evaluated by the ultrasonic miniture probe (UMP) as well as endoscopic findings at the end of therapy. The procedure of eEVL is as follows. During the first and second therapy the endoscopist ligated the varices in two places daiogonally just below the esophagogastric mucosal juncton (EG-j) and then ligated other higher varices at another diagonal at the nearest level possible. These procedures were repeated until 8-10cm above EG-j. After the second'therapy endoscopist ligated only a part of the varices and/or non-variceal area between ulcers formed by Previous EVLs. eEVL was performed at intervals of one to two weeks. The mean frequency of treatmentwas 4.2±0.8. The mean total number of O-rings used for eEVL was 40.4±11.6. Complete eradication of varices was obtained in all cases without any serious complications. After eEVL there were no varices in the mucosal and s'ubmucosal layers in the lower esophagus. Thickened those 2 layers (3mm or more) compared with the layers before eEVL was observed in UMP imagings. Therefore eEVL is proven itself to be more effective and free of serious complications in comparison with standard EVL treatment.