Esophageal variceal banding--the local experience

Banding of esophageal varices was done in 29 patients suffering from acute variceal bleeding. In 13 patients this was the first bleed while in 16 it was recurrent. Five patients had large grade III (polypoid) varices while others had grade II varices. Banding was done using multi band ligator and 4-6 bands were fired per session. Repeat endoscopy at 3 weeks revealed persistence of varices requiring second session of banding in 11 cases and small varices (difficult to band) in 9 cases. Two patients expired due to persistent bleeding and 2 bled from esophageal ulcers. Both patients settled with conservative treatment. A third session of banding was required in 5 cases only. None of the cases developed any major complication. In our setting where expertise for sclerotherapy is scarce and cost of sclerosants is high; banding appears to be a cost effective modality for the management of variceal bleeding with a low complication rate.