Results of experimental endoscopic esophageal varix ligation

Endoscopic Variceal ligation (EVL) is performed using a flexible gastroscope and a recently developed elastic band ligating device. Varices from 3-5 mm in diameter were created in a canine model. Thirty seven variceal sites underwent EVL with successful ligation on first attempt in 34 (92%). Gross and microscopic examination of treated sites at 1-60 days showed ischemic necrosis of mucosa and submucosa (24 hours), acute inflammation, demarcation of viable and necrotic tissue, and appearance of granulation tissue (3-7 days), full thickness replacement of mucosa and submucosa with maturing scar tissue and near complete re-epithelialization (14-21 days), and complete healing (50-60 days). Inflammation and scar tissue deposition consistently obliterated submucosal venous channels but left muscularis propria intact. No perforations or other adverse clinical or histological effects were observed. EVL treatment of canine esophageal varices appears to result in safe and effective obliteration of vascular channels in the submucosa by a process of inflammation and scar formation.