Endoscopic Variceal Ligation by Use of Transparent Endoscopic Elastic Band Ligating Device

Cho, Sung Won; Shim, Chan Sup; Lee, Joon Seong; Lee, Moon Sung; Park, Chan Wook; Song, Dong Wha; Ryu, Chang Beom; Park, Cheol Ho

Abstract

Endoscopic variceal ligation(EVL) is effective in both emergent and elective treatment of esophageal varices and can be used as a safe alternative to sclerotherapy. However, as yet no transparent ligating device is widely available, the endoscopic view through the present commercial ligating device is so narrow that it is often difficult to both approach the target and accurately define and position the bleeding site. To assess the benifit of transparent EVL device, total 143 patients, 632 sessions, underwent EVL treatment. In 545 sessions the non-transparent, conventional-type ligating devices (Stigmann-Goff ligating devices) were used, whereas in 87 sessions the transparent ligating devices used. 35 patients underwent EVL under active bleeding conditions; in 29 patients a conventional ligation devices, whereas in 6 patients a transparent ligating devices were used. The remaining l08 patients were either electively treated by EVL. The visual fields decreased to 20-30% with the conventional devices, but no change of visual fields were noted with the transparent devices. In electively treated cases by EVL, the times need to ligate one band were not significantly different in the conventional devices (average, 18.5 sec) compared with that in the transparent devices (average, 16.7 sec), but in active bleeding conditions it took a significantly longer times in the conventional devices (mean, 30.7 sec) compared with that in the transparent devices (average, 19.4 sec). The hemostatic success rates in active bleeding conditions were 89.7%(26/29) using the conventional devices, 100%(6/6) using the transparent devices. In conclusion this newly developed transparent ligating device provides an improved visual field and shortens ligating time, especially in active bleeding condition. Therefore EVL using transparent device is more effective method in treatment of esophageal varices, especially active bleeding conditions.