Endoscopic control of bleeding from large gastric varices

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July 2002 • Volume 56 • Number 1

Original Articles

Use of detachable snares and elastic bands for endoscopic control of bleeding from large gastric varices

Moon Sung Lee, MD [MEDLINE LOOKUP]

Young Cho, MD [MEDLINE LOOKUP]

Young Koog Cheon, MD [MEDLINE LOOKUP]

Chang Beom Ryu, MD [MEDLINE LOOKUP]

Jong Ho Moon, MD [MEDLINE LOOKUP]

Young Deok Cho, MD [MEDLINE LOOKUP]

Jin Oh Kim, MD [MEDLINE LOOKUP]

Yun Soo Kim, MD [MEDLINE LOOKUP]

Joon Seong Lee, MD [MEDLINE LOOKUP]

Chan Sup Shim, MD [MEDLINE LOOKUP]

Seoul, Korea

Abstract TOP

Background: Bleeding from gastric varices larger than 2 cm in diameter represents a major limitation for endoscopic hemostasis.

Methods: Endoscopic ligation of gastric varices was performed with detachable snares and elastic bands in 41 patients who had recent bleeding from gastric varices larger than 2 cm in diameter. Gastric varices larger than 2 cm were ligated with detachable snares, and then adjacent small gastric varices were ligated with elastic bands.

Results: Among the 41 patients, 10 of 12 patients with active bleeding and 28 of 29 patients with red color signs at initial endoscopy were successfully treated by endoscopic ligation by using detachable snares and elastic bands. Bleeding recurred early (before variceal eradication) in 4 of 38 patients (10.5%). The overall hemostatic rate for endoscopic ligation was 82.9% (34/41). In 33 of 36 patients (91.7%) who underwent repeated ligation treatments, variceal eradication was nearly complete. Mean follow-up in 30 of 33 patients after eradication of varices was 16.4 months (3-32 months), and 29 of 30 did not have recurrent bleeding. During and after ligation there were no serious complications.

Conclusions: Endoscopic ligation therapy with large detachable snares and elastic bands is safe and effective for treatment of large bleeding gastric varices. (Gastrointest Endosc 2002;56:83-8.)

Publishing and Reprint Information TOP

Received September 24, 2001.

For revision November 2, 2001.

Accepted December 7, 2001.

Current affiliation: Department of Internal Medicine, Institute for Digestive Research, Soon Chun Hyang University, College of Medicine, Seoul, Korea.

Reprint requests: Chan-Sup Shim, MD, Professor of Medicine, Institute for Digestive Research, Digestive Disease Center, College of Medicine, Soon Chun Hyang University, 657 Hannam-Dong, Yongsan-Ku, SeouLl4O-743, Korea.

Supported by a grant from Institute for Digestive Research, Soon Chun Hyang University.

Copyright © 2002 by the American Society for Gastrointestinal Endoscopy

0016-5107/2002/$35.00 + 0 37/1/125104

doi:10.1067/mge.2002.125104