Common Causes

• Liver cirrhosis
• Alcohol-related liver disease
• Chronic hepatitis B or C
• Fatty liver progressing to cirrhosis
• Portal vein thrombosis
• Non-cirrhotic portal hypertension

Symptoms of Varices

Many patients may not have symptoms until bleeding occurs.

Symptoms of Bleeding Varices

• Vomiting blood (hematemesis)
• Black tarry stools (melena)
• Giddiness or fainting
• Weakness
• Low blood pressure
• Severe blood loss/shock

What is Variceal Banding?

Variceal banding or EVL is a procedure where small rubber bands are placed around enlarged esophageal veins using an endoscope.

The band cuts off blood supply to the varix, causing it to shrink and eventually fall off.

Pre-procedure Evaluation

Usually advised tests include:

• CBC
• Liver function test (LFT)
• Renal function test (RFT)
• PT/INR
• Blood group and cross match
• Viral markers:
  • HIV
  • HBsAg
  • HCV

Sometimes additional tests may be advised:

• Ultrasound abdomen
• FibroScan
• ECG / 2D Echo in elderly or cardiac patients

Preparation Before Procedure

• Fasting for 6–8 hours
• Inform doctor about:
  • Blood thinners
  • Liver disease
  • Diabetes
  • Heart disease
  • Allergies

In emergency bleeding cases, the procedure may be done urgently after stabilization.

How is the Procedure Performed?

1. Patient is given local throat spray and usually sedation.
2. A flexible endoscope is passed through the mouth into the esophagus.
3. Varices are identified.
4. A banding device attached to the scope places rubber bands over the swollen veins.
5. Multiple bands may be applied in one sitting.

Procedure Duration

Usually 15–30 minutes.

Is Variceal Banding Painful?

• Procedure itself is generally painless due to sedation.
• Mild discomfort or chest heaviness may occur afterward.
• Some patients experience mild swallowing pain for 2–3 days.

After the Procedure

Immediately After

• Observation for a few hours
• Avoid eating until throat numbness wears off

Diet Advice

Usually advised:

• Liquid diet initially
• Soft diet for 24–48 hours
• Avoid hot, spicy, or hard foods temporarily

Medications

May include:

• Acid suppressants
• Medicines to reduce portal pressure (like beta blockers)
• Antibiotics in bleeding patients

Recovery Time

Most patients recover within:

• 1–2 days for preventive banding
• Slightly longer if done during active bleeding

Hospital stay depends on severity of liver disease and bleeding.

Possible Complications

Although generally safe, complications may include:

• Mild chest pain
• Difficulty swallowing
• Ulcer formation at band site
• Re-bleeding
• Infection
• Rarely esophageal perforation

Seek Emergency Medical Attention If:

• Fresh vomiting of blood
• Severe chest pain
• Fever
• Breathing difficulty
• Black stools continue

Follow-up

Repeat endoscopy is commonly required every 2–4 weeks until varices are eradicated.

Patients with liver cirrhosis need long-term follow-up because varices can recur.

Prevention of Recurrence

• Strict alcohol avoidance
• Treat underlying liver disease
• Regular follow-up endoscopy
• Take prescribed medicines regularly
• Maintain healthy diet and weight
• Vaccination for hepatitis when appropriate

When to See a Doctor Urgently

Seek immediate medical care if the patient develops:

• Vomiting blood
• Black stools
• Sudden weakness
• Dizziness or fainting
• Confusion
• Severe abdominal swelling

Variceal bleeding is a medical emergency and requires urgent treatment.