Endoscopic Ligation of Esophageal Varices Using a Detachable Snare and Transparent Cap with Rim

Abstract

The authors developed a new method of endoscopic varix ligation (EVL) using a detachable snare and a transparent cap with rim (EVLsc). The advantages of EVLsc are as follows ; 1 ) no need for an overtube, 2) multiple varix ligation can be achieved in a relatively short time after an easy preparation, and 3) the procedure is associated with less discomfort for the patient. Between August 1995 and December 1996, 31 patients with esophageal varices were treated in Sakura National Hospital by EVL, and were randomized into two groups ; 16 with EVLsc and 15 with conventional EVL. Each patient was treated only by the randomly chosen method for the purpose of achieving complete hemostasis and/ or eradicating esophageal varices at risk for bleeding. The only major complication was pharyngeal injury due to overtube insertion in the EVL group. There were no complications in the EVLsc group. Eradication was achieved in 14 of 16 cases (87.5%) in the EVLsc group, and 13 of 15 (86.7%) in the EVL group, there being no statistically significant difference between the two groups. The EVLsc was not associated with discomfort, required no complex techniques, and satisfactory results were obtained. (Dig Endosc 1997 ; 9 : 183-1 88)

The role of endoscopic therapy in the treatment of bleeding varices

“…Hachisu et al compared the use of single-band ligation with that of detachable snares. 76 The variceal eradication rate was comparable. The only reported complication, pharyngeal injury, occurred with band ligation and was caused by the overtube.…”

“…75 Newer techniques: loops, snares and clips Detachable mini-loops were invented as an alternative to single-band ligators to overcome the disadvantages, such as the need for an overtube and for repeated reintroduction of the endoscope. 76,77 This technique allows the placement of multiple loops without requiring an overtube, and the transparent cylinder oers a nearly uninhibited view. As with band ligation, the treatment causes super®cial ulceration at the ligation site.…”

Variceal Bleeding and Portal Hypertension: Still a Therapeutic Callenge?

“…Hachisu et al [10] compared single-band ligation to ligation therapy using detachable snares with a transparent cylinder in 15 and 16 patients, respectively. The only complication reported occurred in the conventional endoscopic variceal ligation (EVL) group in the form of a pharyngeal injury caused by the overtube.…”