Endoscopic band ligation of oesophageal varices

Background: For 25 years the optimal management of bleeding oesophageal var ices has included endoscopic injection sclerotherapy (EIS) both to arrest b leeding and to prevent rebleeding. However, the recent innovation of endosc opic variceal ligation (EVL) may be a more effective treatment; this paper reviews its efficacy. Methods: All Medline (National Library of Medicine, Washington DC, USA) art icles containing the text words 'oesophageal varices', 'sclerotherapy' or ' band ligation' were reviewed. Prospective randomized studies comparing scle rotherapy with band ligation, or combinations thereof, were included. Results: After an acute variceal bleed EVL is as effective as EIS for contr ol and eradication of oesophageal varices. initial control of bleeding is s imilar, but eradication is achieved in fewer sessions with EVL. EVL is asso ciated with lower rebleeding rates and fewer procedure-related complication s; it is also more effective for control of active bleeding at initial endo scopy. Combination therapy (EIS plus EVL) confers no advantage over EVL alo ne. Conclusion: EVL is similar to EIS for control of bleeding varices, but the former has less associated morbidity, lower rebleeding rates and achieves m ore rapid variceal eradication. EVL should be considered the endoscopic tre atment of choice in the management of variceal haemorrhage.