Banding Down the Hurdles: Evaluating Endoscopic Variceal Ligation for Rectal Varices

Portal hypertension can lead to the formation of rectal varices. Rectal varices are a common manifestation of portal hypertension but tend to bleed less frequently than esophageal or gastric varices. It has been observed that rectal varices can result in significant lower gastrointestinal (GI) bleeding and pose unique therapeutic challenges. This case series evaluates the efficacy and safety of endoscopic variceal ligation (EVL) in treating rectal varices in five patients who presented with lower GI hemorrhage to our center. While Endoscopic Ultrasound (EUS) or Computed Tomography (CT) could provide additional diagnostic insights, these modalities were not routinely used in this series because of the straightforward clinical and endoscopic diagnosis. All patients underwent a successful EVL procedure with complete variceal obliteration. There were no postprocedural complications noted. Six months after the initial course of treatment, a follow-up endoscopy was performed. Overall, one patient required three sessions of EVL, whereas two other patients needed two more sessions. None of the patients had any residual varices at the 5-year follow-up. These findings demonstrate that EVL is an effective treatment modality for rectal varices, particularly in resource-constrained environments. Ongoing endoscopic surveillance is crucial because recurrence is a possibility as seen in many studies. Although our results lend support to the use of EVL, more studies with larger patient populations and longer periods of follow-up are required to validate these findings and improve treatment regimens.