And it has fewer complications. Variceal banding is often done several times to control the varices and prevent bleeding. For example, banding might be repeated every 2 to 4 weeks for 3 to 4 sessions.
Your doctor will monitor check the varices every 3 to 12 months after that for the rest of your life. During endoscopic sclerotherapy, a chemical called a sclerosant may be injected directly into an enlarged vein or into the wall of the esophagus next to the enlarged veins.
The substance causes inflammation of the inside lining of the vein, which over time causes the vein to close off and scar. When the vein is closed off, blood cannot flow through it.
Endoscopic sclerotherapy may be effective for stopping immediate acute bleeding caused by esophageal varices. Sclerotherapy is still done in emergencies, but it is not as popular as it was in the past. More than before, doctors are using variceal banding to treat and prevent esophageal variceal bleeding.
Even if sclerotherapy is done at first, variceal banding is usually done later to prevent future bleeding. Both procedures work. But variceal banding has less chance of complication than sclerotherapy. Complications of endoscopic sclerotherapy are not common. And complications of variceal banding are even less common. If complications do occur, they may include:.
Thomas London MD - Hepatology. Author: Healthwise Staff. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. The most common cause is portal hypertension , which most commonly results from liver cirrhosis. The veins in the esophagus connect to the liver.
These veins can become swollen when there is an obstruction in the flow of blood to the liver. This obstruction causes blood to collect in connecting vessels, including those in the esophagus. As the esophageal veins are small and have thin walls, they cannot contain large amounts of blood. Therefore, the increase in blood flow can cause the veins to swell and rupture. A rupture can be dangerous and even fatal.
Anyone who suspects that they have a bleeding esophageal varice should receive immediate medical attention. Cirrhosis is severe scarring of the liver caused by a disease, such as hepatitis C. It is the most common underlying cause of esophageal varices. Portal hypertension is a complication of cirrhosis. It happens when scar tissue blocks the flow of blood around the liver. This leads to high blood pressure in the portal vein, which carries blood from other organs to the liver.
If blood flow around the liver is restricted, the body sends blood via veins in the stomach or esophagus instead. With more blood flowing through them, these veins can swell, becoming varices. Rarer causes of esophageal varices can include Budd-Chiari syndrome and schistosomiasis.
Budd-Chiari syndrome causes veins in the liver to become partially blocked. Schistosomiasis is a disease caused by parasitic worms. These can get into the blood vessels, which may cause them to become varices. A person with esophageal varices may not have symptoms, particularly if the varices are small. Some people only experience symptoms if the varices bleed. Symptoms of esophageal varices may include :.
A person with liver disease but no cirrhosis has a lower risk of varices. Cirrhosis and portal hypertension are the most common causes of esophageal varices. These are both possible complications of liver disease.
The main risk factors for liver disease include :. A person who has cirrhosis should have regular screening for esophageal varices. To check for these varices, a doctor uses an endoscope , and they may also require a CT scan. The doctor will look for dilated veins, measure them, if found, and check for red streaks and red spots, which usually indicate a significant risk of bleeding. Treatment can be performed during the exam.
An endoscopy procedure involves inserting a long, flexible tube endoscope down your throat and into your esophagus. A tiny camera on the end of the endoscope lets your doctor examine your esophagus, stomach and the beginning of your small intestine duodenum.
The primary aim in treating esophageal varices is to prevent bleeding. Bleeding esophageal varices are life-threatening. If bleeding occurs, treatments are available to try to stop the bleeding. Treatments to lower blood pressure in the portal vein may reduce the risk of bleeding esophageal varices. Treatments may include:. Using elastic bands to tie off bleeding veins.
If your esophageal varices appear to have a high risk of bleeding, or if you've had bleeding from varices before, your doctor might recommend a procedure called endoscopic band ligation. Using an endoscope, the doctor uses suction to pull the varices into a chamber at the end of the scope and wraps them with an elastic band, which essentially "strangles" the veins so they can't bleed.
Endoscopic band ligation carries a small risk of complications, such as bleeding and scarring of the esophagus. Bleeding esophageal varices are life-threatening, and immediate treatment is essential. Treatments used to stop bleeding and reverse the effects of blood loss include:. Diverting blood flow away from the portal vein. If medication and endoscopy treatments don't stop the bleeding, your doctor might recommend a procedure called transjugular intrahepatic portosystemic shunt TIPS.
The shunt is an opening that is created between the portal vein and the hepatic vein, which carries blood from your liver to your heart.
The shunt reduces pressure in the portal vein and often stops bleeding from esophageal varices. But TIPS can cause serious complications, including liver failure and mental confusion, which can develop when toxins that the liver normally would filter are passed through the shunt directly into the bloodstream. TIPS is mainly used when all other treatments have failed or as a temporary measure in people awaiting a liver transplant. Placing pressure on varices to stop bleeding. If medication and endoscopy treatments don't work, doctors may try to stop bleeding by applying pressure to the esophageal varices.
One way to temporarily stop bleeding is by inflating a balloon to put pressure on the varices for up to 24 hours, a procedure called balloon tamponade. Balloon tamponade is a temporary measure before other treatments can be performed, such as TIPS. This procedure carries a high risk of bleeding recurrence after the balloon is deflated. Balloon tamponade may also cause serious complications, including a rupture in the esophagus, which can lead to death. There is a high risk that bleeding will recur in people who've had bleeding from esophageal varices.
Beta blockers and endoscopic band ligation are the recommended treatments to help prevent re-bleeding. After initial banding treatment, your doctor will repeat your upper endoscopy at regular intervals and apply more bands if necessary until the esophageal varices are gone or small enough to reduce the risk of further bleeding.
Doctors are exploring an experimental emergency therapy to stop bleeding from esophageal varices that involves spraying an adhesive powder.
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