Esophagus and Gastric Varices. El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
This is the case of a 49 year-old male with liver disease secondary to alcoholic cirrhosis. Esophageal varices are dilated blood vessels within the wall of the esophagus. Patients with cirrhosis develop Portal Hypertension. When Portal Hypertension occurs, blood flow through the liver is diminished. Thus, blood flow increases through the microscopic blood vessels within the esophageal wall. As this blood flow increases, the blood vessels begin to dilate. This dilation can be profound. The original diameter the of blood vessels is measured in millimetres while the final, fully established, esophageal varix may be 0.5 to 1.0 cm or larger in diameter.

Video Endoscopic Sequence 1 of 6.

 This is the case of a 49 year-old male with liver disease
 secondary to alcoholic cirrhosis.

 Esophageal varices are dilated blood vessels within the
 wall of the esophagus. Patients with cirrhosis develop
 Portal Hypertension. When Portal Hypertension occurs,
 blood flow through the liver is diminished. Thus, blood flow
 increases through the microscopic blood vessels within the
 esophageal wall. As this blood flow increases, the blood
 vessels begin to dilate. This dilation can be profound. The
 original diameter the of blood vessels is measured in
 millimeters while the final, fully established, esophageal
 varix may be 0.5 to 1.0 cm or larger in diameter.

 For more endoscopic details, download the video clip
 by clicking on the endoscopic image. Wait to be
 downloaded complete then Press Alt and Enter for full
 screen.
 All endoscopic images shown in this Atlas contain
 video clips. We recommend seeing the video clips in full
 screen mode.
This patient has lager esophageal varices as well as gastric varices. These blood vessels then continue to dilate until they become large enough to rupture. When esophageal varices rupture, patients become acutely ill. In fact, 50 percent of patients with esophageal varices will eventually bleed from the varices. The mortality rate for esophageal variceal bleeding, on the first event, is between 40 and 70 percent. Mortality is due to multiple factors

Video Endoscopic Sequence 2 of 6.

 This patient has lager esophageal varices as well as
 gastric varices.

 These blood vessels then continue to dilate until they
 become large enough to rupture. When esophageal varices
 rupture, patients become acutely ill. In fact, 50 percent of
 patients with esophageal varices will eventually bleed from
 the varices. The mortality rate for esophageal variceal
 bleeding, on the first event, is between 40 and 70 percent.
 Mortality is due to multiple factors.

 
Gastric Varices. Multiple large gastric varices can be seen in the gastric cardias and fundus. Varices are shown here in the gastric cardias, seen on retroflexion of the endoscope.

Video Endoscopic Sequence 3 of 6.

Gastric Varices.

Multiple large gastric varices can be seen in the gastric cardia and fundus.

 Varices are shown here in the gastric cardia, seen on
 retroflexion of the endoscope.
 

 
Gastric varices can be a perplexing problem for gastroenterologists to manage. These vascular channels can be large and deep, and bleeding can be difficult to control

Video Endoscopic Sequence 4 of 6.

 Gastric varices can be a perplexing problem for
 gastroenterologists to manage. These vascular channels
 can be large and deep, and bleeding can be difficult to
 control.

 
Larger Gastric Varices of the Gastric Cardias.

Video Endoscopic Sequence 5 of 6.

Larger Gastric Varices of the Gastric Cardias.
Variceal appearance on Endoscopy ("red signs"). Red wale marks (longitudinal red streaks on varices). Cherry-red spots (red, discrete, flat spots on varices). Hematocystic spots (red, discrete, raised spots). Diffuse erythema. Esophageal varices are enlarged veins in the esophagus - usually the lower part of the esophagus. They're often due to obstructed blood flow through the portal vein, which carries blood from the intestine and spleen to the liver.

Video Endoscopic Sequence 6 of 6.

Variceal appearance on endoscopy ("red signs")

  • · Red wale marks (longitudinal red streaks on varices)
  • · Cherry-red spots (red, discrete, flat spots on varices)
  • · Hematocystic spots (red, discrete, raised spots)
  • · Diffuse erythema
  • Esophageal varices are enlarged veins in the esophagus — usually the lower part of the esophagus. They're often due to obstructed blood flow through the portal vein, which carries blood from the intestine and spleen to the liver.
An 83 year-old, non-alcoholic female that had an upper gastrointestinal hemorrhage. Esophageal varices are dilated blood vessels within the wall of the esophagus. Patients with cirrhosis develop Portal Hypertension. When Portal Hypertension occurs, blood flow through the liver is diminished. Thus, blood flow increases through the microscopic blood vessels within the esophageal wall. As this blood flow increases, the blood vessels begin to dilate. This dilation can be profound. The original diameter of the blood vessels is measured in millimeters while the final, fully established, esophageal varix may be 0.5 to 1.0 cm or larger in diameter.

Video Endoscopic Sequence 1 of 4.

 An 83 year-old, non-alcoholic female that had an upper
 gastrointestinal hemorrhage. 
 
 Esophageal varices are dilated blood vessels within the
 wall of the esophagus. Patients with cirrhosis develop
 Portal Hypertension. When Portal Hypertension occurs,
 blood flow through the liver is diminished. Thus, blood flow
 increases through the microscopic blood vessels within the
 esophageal wall. As this blood flow increases, the blood
 vessels begin to dilate. This dilation can be profound. The
 original diameter of the blood vessels is measured in
 millimeters while the final, fully established, esophageal
 varix may be 0.5 to 1.0 cm or larger in diameter.
 Bleeding varices are a life-threatening complication of
 portal hypertension (increased blood pressure in the portal
 vein caused by liver disease). Increased pressure causes
 the veins to balloon outward. The vessels may rupture,
 causing vomiting of blood and bloody stools or tarry black
 stools. If a large volume of blood is lost, signs of shock will
 develop. Any cause of chronic liver disease can cause
 bleeding varices.

 
Esophageal varices the venous structures are tortuous in appearance. The best predictor of variceal hemorrhage is the size of the varices. Several studies have shown that large varices are more likely to bleed than small one.

Video Endocopic Sequence 2 of 4.

 Sequences of images and videos of a case on esophageal
 varices.
 Esophageal varices the venous structures are tortuous
 in appearance. 
 The best predictor of variceal hemorrhage is the
 size of the varices. Several studies have shown that large
 varices are more likely to bleed than small one.
Small Varices of the epiglottis. Same patient as described above.

Video Endoscopic Sequence 3 of 4.

 Small Varices of the epiglottis. Same patient as described
 above.


 
 
Large tortuous varices with red color sign. Cherry red spots are signs of imminent hemorrhage.

Video Endoscopic Sequence 4 of 4.

 Large tortuous varices with red color sign.
 Cherry red spots are signs of imminent hemorrhage.

Classification of gastroesophageal varices.

Esophageal.

 Small, straight.
 Enlarged, tortuous; occupy less than one third of the lumen.
 Large, coil-shaped; occupy more than one third of the
 lumen.

Gastric.

 In continuity with esophageal varices.
 Along lesser curve (2 to 5 cm long).
 Along greater curve extending toward the fundus Isolated
 In the fundus.
 Elsewhere in the stomach.
String of Pearls Varices of the Esophagus. Portal hypertension must be present with pressures more of 12 mm Hg or greater in order for varices to develop. However the level of pressure elevation does not correlate with the risk of rupture.

“ String of Pearls “ Varices of the Esophagus.

 Portal hypertension must be present with pressures more
 of 12 mm Hg or greater in order for varices to develop.
 However the level of pressure elevation does not correlate
 with the risk of rupture. 

 

Esophageal Varices. Hematocystic spots are seen that are stigmata of recent hemorrhage. A 61 year-old woman that was under hepatic transplant program in a United States Hospital. She returned to her country El Salvador, and the same day that she arrived, she was hospitalized because of her first hemorrhage.

Esophageal Varices.

 Hematocystic spots are seen that are stigmata of recent
 hemorrhage.
 A 61 year-old woman that was under hepatic transplant
 program in a United States Hospital. She returned to her
 country El Salvador, and the same day that she arrived, she
 was hospitalized because of her first hemorrhage.

85 year-old man with esophageal varices. Due to alcoholic cirrhosis. A variety of factors affect the prognosis of a patient with variceal bleeding. Patients with alcoholic cirrhosis usually have a poor prognosis, with few 5-year survivors irrespective of treatment. On the other hand, complete abstinence from alcohol can improve the prognosis and result in both lowering of portal pressure and reduction in the size of the varices. The main causes of portal hypertension can be classified anatomically: pre hepatic (portal vein thrombosis), hepatic (mainly cirrhosis, schistosomiasis and rarer causes) and post hepatic (Budd-Chiari and rarer causes).

 85 year-old man with esophageal varices.

Due to alcoholic cirrhosis.

 A variety of factors affect the prognosis of a patient with
 variceal bleeding. Patients with alcoholic cirrhosis usually
 have a poor prognosis, with few 5-year survivors
 irrespective of treatment. On the other hand, complete
 abstinence from alcohol can improve the prognosis and
 result in both lowering of portal pressure and reduction in
 the size of the varices.
 The main causes of portal hypertension can be classified
 anatomically: pre hepatic (portal vein thrombosis), hepatic
 (mainly cirrhosis, schistosomiasis and rarer causes) and
 post hepatic (Budd-Chiari and rarer causes). 

Unique Varix of the Esophagus. Finding a isolated varix of the mild esophagus is without portal hypertension and no clinical importance.

Unique Varix of the Esophagus.

 Finding a isolated varix of the mild esophagus is without
 portal hypertension and no clinical importance.
 
Variceal Bleeding. One of the most ominous complications of portal hypertension is hemorrhage from esophageal or gastric varices. Patients who bleed from varices have a poor long-term prognosis, irrespective of treatment and fewsurvive more than 5 years. In view of the prognosis of portal hypertensive bleeding, it is essential to have an urgent treatment of acute variceal bleeding and interval management, in order to prevent rebleeding.

Variceal Bleeding.

 One of the most ominous complications of portal
 hypertension is hemorrhage from esophageal or gastric
 varices. Patients who bleed from varices have a poor
 long-term prognosis, irrespective of treatment and few
 survive more than 5 years. In view of the prognosis of
 portal hypertensive bleeding, it is essential to have an
 urgent treatment of acute variceal bleeding and interval
 management, in order to prevent rebleeding.
Endoscopic sequence using magnifying endoscope. and aimed dedicated for portal hypertensive gastropathy.

Video Endoscopic Sequence 1 of 5.

Esophageal Varices.

 This endoscopic sequence is taken with magnifying
 endoscope and aimed dedicated for portal hypertensive
 gastropathy.
Another variant of portal hypertension is portal hypertensive gastropathy. It affects to 50 percent of patients with portal hypertension. These patients have dilated arterioles and venules (small veins). This abnormality is seen usually in the fundus and cardia of the stomach (approximately 2/3 of the stomach). It is rarely seen in the antrum (last 1/3) of the stomach. It appears to have a snake skin or reticulated appearance.

Video Endoscopic Sequence 2 of 5.

 Another variant of portal hypertension is portal
 hypertensive gastropathy. It affects to 50 percent of
 patients with portal hypertension. These patients have
 dilated arterioles and venules (small veins). This
 abnormality is seen usually in the fundus and cardia of the
 stomach (approximately 2/3 of the stomach). It is rarely
 seen in the antrum (last 1/3) of the stomach. It appears to
 have a "snake skin " or "reticulated" appearance.
The image and the video clip display a portal hypertensive gastropathy using a magnifying endoscope. Long-term treatment of portal gastropathy and gastric varices is with beta-blockers. They usually take the form of propranolol, a nonselective beta-blocker. These medications allow the pressure within the veins to be decreased, thus reducing the chance that bleeding will occur. Increased incidence of portal hypertensive gastropathy is noted in patients who undergo sclerotherapy for esophageal varices in the past.

 Video Endoscopic Sequence 3 of 5.

 The image and the video clip display a portal
 hypertensive gastropathy using a magnifying endoscope.
 
 Long-term treatment of portal gastropathy and gastric
 varices is with beta-blockers. They usually take the form of
 propranolol, a nonselective beta-blocker.
 These medications allow the pressure within the veins to be
 decreased, thus reducing the chance that bleeding will
 occur. Increased incidence of portal hypertensive
 gastropathy is noted in patients who undergo sclerotherapy
 for esophageal varices in the past.
Bleeding from portal hypertensive gastropathy accounts for 2.3% of bleeding episodes in cirrhosis. Although serious bleeding from these sources is uncommon.

Video Endoscopic Sequence 4 of 5.

 Bleeding from portal hypertensive gastropathy accounts for
 2.3% of bleeding episodes in cirrhosis. Although serious
 bleeding from these sources is uncommon.
Portal hypertensive gastropathy (PHG) is the most common gastric mucosal injury to patients with liver cirrhosis. Portal hypertensive gastropathy (PHG) is the most common gastric mucosal injury to patients with liver cirrhosis. The main histological change is that blood vessels in the mucosa and submucosa become dilated and twisted, and the vessel wall become thickened. In fact, PHG is the major factor in patients with liver cirrhosis who were accompanied with upper gastrointestinal hemorrhage. Therefore, to prevent and cure PHG is particularly important in preventing upper gastrointestinal hemorrhage in patients with liver cirrhosis. Hp infection is closely related to peptic ulcer, chronic gastritis, and gastric cancer; but the relationship between Hp infection and PHG is not clear.

Video Endoscopic Sequence 5 of 5.

 Portal hypertensive gastropathy (PHG) is the most common
 gastric mucosal injury to patients with liver cirrhosis. The
 main histological change is that blood vessels in the mucosa
 and submucosa become dilated and twisted, and the vessel
 wall become thickened. In fact, PHG is the major factor in
 patients with liver cirrhosis who were accompanied with
 upper gastrointestinal hemorrhage. Therefore, to prevent
 and cure PHG is particularly important in preventing upper
 gastrointestinal hemorrhage in patients with liver cirrhosis.
 Hp infection is closely related to peptic ulcer, chronic
 gastritis, and gastric cancer; but the relationship between
 Hp infection and PHG is not clear.

 
Pseudo Schatzki Ring. The image and the video clip show some scar of previous treatment for varices with banding, those varix were eradicated one year ago, the patient had two previous variceal hemorrhage.

Pseudo Schatzki Ring.

 The image and the video clip show some scar of previous
 treatment for varices with banding, those varix were
 eradicated one year ago, the patient had two previous
 variceal hemorrhage. 

Peptic ulcer has been reported with increased frequency in patients with liver cirrhosis, its prevalence ranging form 5% to 20%

Video Endoscopic Sequence 1 of 5.

 Peptic Ulcer and Liver Cirrhosis.

 This 84 year-old male who was hospitalized due a urosepsis
 and melena one week before underwent a Transurethral
 prostatectomy, no previous medical history of liver
 cirrhosis was know.

 Peptic ulcer has been reported with increased frequency in
 patients with liver cirrhosis, its prevalence ranging form 5%
 to 20%.
Portal Hypertensive Gastropathy. a "snake skin" like gastric mucosal pattern consistent with portal hypertensive gastropathy.

Video Endoscopic Sequence 2 of 5.

Portal Hypertensive Gastropathy.

 A "snake skin" like gastric mucosal pattern consistent with
 portal hypertensive gastropathy.

 
Portal Hypertensive Gastropathy.

Video Endoscopic Sequence 3 of 5.

Portal Hypertensive Gastropathy.

 Portal hypertensive gastropathy is a potential cause of
 bleeding in patients with liver cirrhosis.

 
More images and video clips.

Video Endoscopic Sequence 4 of 5.

More images and video clips.

 
Through the cardias the gastric body is observed with Portal Hypertensive Gastropathy, the video clip shows esophageal varices.

Video Endoscopic Sequence 5 of 5.

 Through the cardias the gastric body is observed with
 portal hypertensive gastropathy, the video clip shows
 esophageal varices.

 
Portal hypertensive gastropathy and gastric antral vascular ectasias (GAVE) are both potential causes of upper GI bleeding. While they can be seen in patients with cirrhosis, it is quite uncommon to find them in the same patient. In portal hypertensive gastropathy, the mucosa is friable and bleeding occurs when the ectatic vessels rupture and manifest as mucosal oozing. The characteristic endoscopic appearance of fine white reticular pattern separating the areas of pinkish mucosa has been described as "snake skin" . The pathogenesis of this disorder involves congestion and hyperemia of the mucosa.. GAVE or watermelon stomach characterized by rows of flat reddish stripes radiating from the pylorus, which can sometimes be confused with portal hypertensive gastropathy. While it can be seen in patients with cirrhosis, most cases are idiopathic. Portal decompression with TIPS does not reduce bleeding caused by GAVE. Antrectomy is reserved as a last option for patients who fail endoscopic therapies. Endoscopic coagulation with heater probe, gold probe or argon plasma coagulator (APC) obliterates the vascular ectasias and reduces the degree of blood loss . More than one session may be needed.

Video Endoscopic Sequence 1 of 6.

 Gastric Antral Vascular Ectasias (GAVE).

 This 54 year-old alcoholic male had melena and stigmata of
 bleeding in an previous endoscopy one week before to
 this one, presented with ascitis and esophageal varices that
 were ligated in three different sessions.

 Portal hypertensive gastropathy and gastric antral vascular
 ectasias (GAVE) are both potential causes of upper GI
 bleeding. While they can be seen in patients with cirrhosis,
 it is quite uncommon to find them in the same patient. In
 portal hypertensive gastropathy, the mucosa is friable and
 bleeding occurs when the ectatic vessels rupture and
 manifest as mucosal oozing. The characteristic endoscopic
 appearance of fine white reticular pattern separating the
 areas of pinkish mucosa has been described as "snake
 skin" . The pathogenesis of this disorder involves
 congestion and hyperemia of the mucosa.

 GAVE or watermelon stomach characterized by rows of
 flat reddish stripes radiating from the pylorus, which
 can sometimes be confused with portal hypertensive
 gastropathy. While it can be seen in patients with cirrhosis,
 most cases are idiopathic. Portal decompression with
 TIPS does not reduce bleeding caused by GAVE.
 Antrectomy is reserved as a last option for patients who
 fail endoscopic therapies. Endoscopic coagulation with
 heater probe, gold probe or argon plasma coagulator (APC)
 obliterates the vascular ectasias and reduces the degree of
 blood loss . More than one session may be needed.

 
There was extensive vascular ectasia in the distal stomach. Background: Gastric Antral Vascular Ectasia or Watermelon stomach is a rare cause of chronic gastrointestinal bleeding, often presenting as a chronic iron deficiency anemia. This condition can be associated with some other diseases such as cirrhosis, autoimmune diseases and others. We report two patients treated with Argon Plasma Coagulation, a 68 years old male with an ethanol related cirrhosis and a 72 years old female with an idiopathic Gastric Antral Vascular Ectasia. The characteristic endoscopic features were mistaken for many years as gastritis. Both patients presented with severe anemia requiring multiple transfusions as treatment. Due to the poor operative risk, both patients were treated with Argon Plasma Coagulation with good results

Video Endoscopic Sequence 2 of 6.

There was extensive vascular ectasia in the distal stomach.

 Background: Gastric Antral Vascular Ectasia or
 Watermelon stomach is a rare cause of chronic
 gastrointestinal bleeding, often presenting as a chronic
 iron deficiency anemia. This condition can be associated
 with some other diseases such as cirrhosis, autoimmune
 diseases and others. We report two patients treated with
 Argon Plasma Coagulation, a 68 years old male with an
 ethanol related cirrhosis and a 72 years old female with an
 idiopathic Gastric Antral Vascular Ectasia. The
 characteristic endoscopic features were mistaken for many
 years as gastritis. Both patients presented with severe
 anemia requiring multiple transfusions as treatment. Due
 to the poor operative risk, both patients were treated with
 Argon Plasma Coagulation with good results.

 

Video Endoscopic Sequence 3 of 6.

 

There was extensive vascular ectasia in the distal stomach.

 Portal hypertensive gastropathy and gastric antral vascular
 ectasias (GAVE) are both potential causes of upper GI
 bleeding. While they can be seen in patients with cirrhosis,
 it is quite uncommon to find them in the same patient. In
 portal hypertensive gastropathy, the mucosa is friable and
 bleeding occurs when the ectatic vessels rupture and
 manifest as mucosal oozing. The characteristic endoscopic
 appearance of fine white reticular pattern separating the
 areas of pinkish mucosa has been described as "snake
 skin" . The pathogenesis of this disorder involves
 congestion and hyperemia of the mucosa.
Endoscopic coagulation with heater probe, gold probe or argon plasma coagulator (APC) obliterates the vascular ectasias and reduces the degree of blood loss . More than one session may be needed.

Video Endoscopic Sequence 4 of 6.

 Endoscopic coagulation with heater probe, gold probe or
 argon plasma coagulator (APC) obliterates the vascular
 ectasias and reduces the degree of blood loss . More than
 one session may be needed.

 GAVE or watermelon stomach characterized by rows of flat
 reddish stripes radiating from the pylorus, which can
 sometimes be confused with portal hypertensive
 gastropathy. While it can be seen in patients with cirrhosis,
 most cases are idiopathic.

 
Argon plasma coagulation (APC) is a new noncontact electocoagulation technique which has several theoretical advantages over laser.

Video Endoscopic Sequence 5 of 6.

 Argon plasma coagulation (APC) is a new noncontact
 electocoagulation technique which has several theoretical
 advantages over laser.

 
APC is a safe and effective short-term treatment for GAVE. The natural history of the condition is uncertain, and at medium-term follow-up GAVE is found to recur in a substantial number of patients treated with APC. Re-treatment with APC is an option in these patients.

Video Endoscopic Sequence 6 of 6.

The image as well as the video clip display the status post
APC.

 APC is a safe and effective short-term treatment for
 GAVE. The natural history of the condition is uncertain,
 and at medium-term follow-up GAVE is found to recur in a
 substantial number of patients treated with APC.
 Re-treatment with APC is an option in these patients.
 

 

 
Post sclerotherapy esophageal ulcer. Severe persistent chest pain and pyrexia after sclerotherapy are clinical pointers of ulcerogenesis.

Video Endoscopic Sequence 1 of 2.

Post Sclerotherapy Esophageal Ulcer.

 Severe persistent chest pain and pyrexia after
 sclerotherapy are clinical pointers of ulcerogenesis.
 

 

 
Another image and video clip.

Video Endoscopic Sequence 2 of 2.

Another image and video clip.

 
This 70 year-old female, presented an upper gastrointestinal bled due to Esophageal varix, six months previously had two sessions of Esophageal banding with six varices ligated each time.

Video Endoscopic Sequence 1 of 12.

 This 70 year-old female, presented an upper
 gastrointestinal bled due to esophageal varix, six months
 previously had two sessions of esophageal banding with six
 varices ligated each time.

This image shows a blood clot where identify the site of the bleeding.

Video Endoscopic Sequence 2 of 12.

This image shows a blood clot where identify the site of the bleeding.

 

 
The gastric camera has rest of blood.

Video Endoscopic Sequence 3 of 12.

The gastric camera has rest of blood.

 
After careful examination the bleeding has been reactivated.

Video Endoscopic Sequence 4 of 12.

 After careful examination the bleeding has been reactivated.

Red brilliant blood is emerging from the site of the hemorrhage observed in the GI junction.

Video Endoscopic Sequence 5 of 12.

Red brilliant blood is emerging from the site of the hemorrhage observed in the GI junction.

To localize the exact site some vigorous washing with water is performed, the next video clips were taken with the double channel therapeutical endoscope.

Video Endoscopic Sequence 6 of 12.

 To localize the exact site some vigorous washing with water
 is performed, the next video clips were taken with the
 double channel therapeutical endoscope that perform a
 better suction of the blood.      
This image and the video clip shows the exact site of this hemorrhage.

Video Endoscopic Sequence 7 of 12.

This image and the video clip shows the exact site of this hemorrhage.
In order to stop the hemorrhage, the argon plasma coagulator is being used. Endoscopic variceal ligation is an established procedure for eradication of esophageal varices. However, varices frequently recur after endoscopic variceal ligation. Argon plasma coagulation has been used as supplemental treatment for eradication of varices and for prevention of variceal recurrence in small uncontrolled series.

Video Endoscopic Sequence 8 of 12.

Efficacy of argon plasma coagulation in variceal upper gastrointestinal bleeding.

In order to stop the hemorrhage, the argon plasma coagulator is being used. The catheter of the argon
 plasma coagulator is observed that will initiate the
 therapeutical approach.

 Endoscopic variceal ligation is an established procedure
 for eradication of esophageal varices. However, varices
 frequently recur after endoscopic variceal ligation. Argon
 plasma coagulation has been used as supplemental
 treatment for eradication of varices and for prevention of
 variceal recurrence in small uncontrolled series.

 
Various methods of endoscopic hemostasis for esophageal varices have been described, sclerotherapy, rubber band ligation, hemoclips etc.

Video Endoscopic Sequence 9 of 12.

Various methods of endoscopic hemostasis for esophageal varices have been described, sclerotherapy, rubber band ligation, hemoclips etc.

 
Efficacy of argon plasma coagulation in variceal bleeding.

Video Endoscopic Sequence 10 of 12.

Efficacy of argon plasma coagulation in variceal bleeding.

 
The varix was successfully coagulated.

Video Endoscopic Sequence 11 of 12.

The varix was successfully coagulated.
This image shows the status post coagulation of the varix. The hemorrhage has been stopped.

Video Endoscopic Sequence 12 of 12.

This image shows the status post coagulation of the varix.
The hemorrhage has been stopped.