Endoscopic Ligation of Gastric Varices using a Detachable Snare

Abstract

A new technique of endoscopic treatment for gastric varices is presented here, which was applied in 10 patients, either electively (n = 9) or as emergency therapy for bleeding (n = 9) or as emergency therapy for bleeding (n = 1). A detachable snare is placed endoscopically, tightened around the varix, and then detached using a similar principle to that of band ligation. Following one or two treatment sessions (one snare applied in seven cases, two snares applied in three cases), eradication of gastric varices was observed in all patients. No significant complications were encountered, and nine of 13 snares passed spontaneously, the remaining ones being removed when found during follow-up endoscopy. Short-term follow-up (4-12 months, mean: 7.2 months) did not show either reappearance of varices or rebleeding in any of the patients. Angiography and endoscopic ultrasonography performed in four patients before and after treatment showed regression or disappearance of intramural vessels. Further studies will show the relative value of this new technique compared to other treatment modalities such as banding or cyanoacrylate injection.

A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-Butyl-2-Cyanoacrylate injection versus band ligation

“…To set a conclusion of equal efficacy in controlling active bleeding, a large case number trial based on active bleeding is needed. The success rate of GVL was also comparable to that of previous studies 6,7,36 but higher than the rate in Lo et al's study. 13 The difference in the success rates of bleeding control between studies may be attributable to different technical applications.…”

“…The rebleeding rate (11/49) of GVO was comparable to those of previous studies (18.5%-31%). 9,13,35 The rebleeding rate (21/48) of GVL was higher than previous studies 6,7,36 but similar to Lo et al's study. 13 The discrepancy is possibly attributable to heterogenicity between these studies such as acute treatment basis versus elective basis, concomitance of HCC, different technical applica- Fig.…”

Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Varices: A Feasibility Study

“…However, the direct injection of cyanoacrylate into the varices under endoscopy may be accompanied by the serious problem of multiple organ embolisms due to dispersion of sclerosant into the systemic circulation [13], and ulceration and/or bleeding at the puncture site. Endoscopic variceal ligation has a high incidence of recurrent gastric varices [14]. Endoscopic sclerotherapy cannot be performed in gastric fundic varices in a large number of patients.…”

Endoscopic hemostasis for bleeding gastric varices treated by combination of variceal ligation and sclerotherapy with N-butyl-2-cyanoacrylate

“…1 The frequency of bleeding from gastric varices is lower than that from esophageal varices, but can be extremely severe. [2][3][4][5][6] Despite many advances, including surgical 7 and endoscopic approaches, [8][9][10] in the management of active bleeding from gastric varices, ideal fi rst-choice therapies are still a great challenge because of massive bleeding 6,11,12 and complications. [13][14] Variable success with endoscopic injection sclerotherapy (EIS) using various sclerosants for variceal bleeding has been reported.…”