Clinical experience of endoscopic banding ligation for bleeding gastric varices

Endoscopic variceal ligation is now regarded as the treatment of choice for bleeding esophageal varices. However, it is seldom used to treat bleeding gastric varices. In this a clinical experience of banding ligation to treat bleeding gastric varices is reported.

There were 17 male and 5 female patients with active gastric variceal bleeding who received banding ligation. The gastric varices were ligated using pneumoactive ligating devices and an attempt was made to ligate all engorged varices at 1 session. After endoscopic treatment, intravenous omeprazole 40 mg q12 h was given.

An average of 2.8 bands were used (1-5 bands) to ligate the gastric varices at 1 session. All achieved initial hemostasis and there was no immediate complication. However, 4 patients (18.2%) developed early rebleeding and it occurred on the 3rd, 5th, 9th, 14th days after banding ligation respectively. Three of these 4 patients had Grade III gastric varices. Three (13.6%) patients died within 30 days. One died of hepatic failure, one of hepatocellular carcinoma and one of uncontrolled bleeding.

Variceal ligation is effective for hemostasis of bleeding gastric varices. However, early rebleeding is still a problem and more often encountered with larger gastric varices.