THE USE OF A DETACHABLE MINI-LOOP FOR THE TREATMENT OF ESOPHAGEAL-VARICES

Background: Endoscopic variceal ligation is facilitated by multiband l igating devices, but these have limitations including a fixed number o f bands, occasional failure to firmly ligate a variceal column, and re latively high cost. We report the use of a mini-loop for treatment of esophageal varices. Methods: A detachable nylon ring (mini-loop), maxi mum diameter 11 mm, passed through the accessory channel of a standard endoscope is opened at the rim of a transparent ligation chamber atta ched to the instrument. By suction, a varix is brought into the chambe r, the mini-loop is maneuvered over the varix, closed, and detached. R esults: Five ligation sessions (four to seven loops per session) were performed in four patients with upper gastrointestinal bleeding. There were variceal stigmata of bleeding, but no active hemorrhage. Applica tion of all mini-loops was successful and did not induce uncontrolled bleeding. Endoscopy at 1 week disclosed superficial ulcers at ligation sites. Post procedure epigastric pain occurred in one patient. Conclu sion: Detachable mini-loop ligation of esophageal varices is simple an d safe, and a comparison study with a multi-band ligator device is war ranted.