 |
|
 |
Video Endoscopic Sequence 1 of 5.
Bleeding from Varices of the Esophagus
A 42-year-old male, who suffers from alcoholic liver cirrhosis, presents his second episode of bleeding. The first had presented 5 years previous.
|
|
 |
Video Endoscopic Sequence 2 of 5.
The varix responsible for bleeding, a band will be applied
A varix with a white spot (ulcer) is displayed, The exact site of the bleeding has been identified.
|
|
 |
Video Endoscopic Sequence 3 of 5.
The varix was successfully ligated.
|
|
 |
Video Endoscopic Sequence 4 of 5.
More varices were ligated
|
|
 |
Video Endoscopic Sequence 5 of 5.
Other varices are ligated
|
|
 |
Video Endoscopic Sequence 1 of 10.
Endoscopic Variceal ligation
Fibrosis due to a Status post banding and variceal hemorrhage due to a varix of the esophagus.
This 33 year-old male with alcoholic cirrhosis since two years ago, underwent rubber bands due to multiple variceal bleeding carrying out three treatments with rubber bands. This one is the fourth episode, this morning started with two episodes of melena, in spite of his disease the patient has continued with his alcoholism. Endoscopy was performed under conscious sedation.
|
|
 |
Video Endoscopic Sequence 2 of 10.
Endoscopy of Variceal ligation
We can see an esophageal varix with a white point (ulcer).
The probable bleeding point has been identified, with extensive fibrosis in the surrounding area because of previous banding sessions.
|
|
 |
Video Endoscopic Sequence 3 of 10.
More image and video clip of the varix and it ulceration
The mucosa and submucosa of the esophagus (containing the variceal channels) are ensnared, leading to strangulation, sloughing, and eventual fibrosis—ideally with obliteration of the varices.
|
|
 |
Video Endoscopic Sequence 4 of 10.
Endoscopic application of rubber band onto the bleeding
site.
The banding treatment has been initiated, due to the fibrosis near of the varix, we have some experience that the band can be slid.
|
|
 |
Video Endoscopic Sequence 5 of 10.
Endoscopic application of rubber band onto the bleeding site.
Jet of blood from an esophageal varix
After several attempts to suck, bleeding is activated but we continued trying to suck until finally sufficient tissue of varix is sucked and two bands go off.
|
|
 |
Video Endoscopic Sequence 6 of 10.
Endoscopic application of rubber band onto the bleeding site.
Important advances have been made in the management of variceal bleeding. Despite these advances, bleeding in the patient with cirrhosis remains one of the most demanding clinical challenges that a gastroenterologist may face.
|
|
 |
Video Endoscopic Sequence 7 of 10.
Endoscopic application of rubber band onto the bleeding site.
Hemostasis achieved in bleeding varix by the endoscopic application of rubber bands onto the bleeding site two bands were deployed.
|
|
 |
Video Endoscopic Sequence 8 of 10.
Endoscopic Variceal ligation
Esophageal varix which have been successfully banded. |
|
 |
Video Endoscopic Sequence 9 of 10.
The varix was successfully ligated.
One band falls, observing the ulcer in the tip of the varix.
|
|
 |
Video Endoscopic Sequence 10 of 10.
Sclerotherapy of adjacent tissues
Due to the considerable amount of fibrous tissue surrounding the vessel, in spite of successful banding of the blood vessel, sclerotherapy was administered in the three upper paravariceal cuadrants, to prevent the band from slipping.
|
|
 |
Video Endoscopic Sequence 1 of 19.
Banding of Esophageal Varices.
This endoscopic sequence displays multiple images and video clips concerning the technique of banding of esophageal varices.
A 65 year-old female who ten years ago presented ascitis due to Ovarian carcinoma, for which she underwent chemotherapy. Apparently the carcinoma was overcame, and she had been asymptomatic ever since. Ten days previously to the endoscopy, the patient presented ascitis.
A CAT scan confirmed the ascitis and micro nodular cirrhosis was detected. We found multiple varices when we performed an upper endoscopy, never had bleeding.
Primary prophylaxis: Patients with cirrhosis who have esophageal varices but who have never had a bleeding episode may be treated medically or endoscopically. Without treatment, approximately 30% of cirrhotic patients with varices bleed and this risk is reduced by approximately 50% with therapy.
|
|
 |
Video Endoscopic Sequence 2 of 19.
Endoscopic Variceal ligation
The cardias presents varices; some with the red sign.
Studies of endoscopic therapy with ligation (endoscopic banding) demonstrate that in select patients (those with large varices), endoscopic banding may reduce the risk of first bleeding episode when compared with propranolol.
Patients with large varices may benefit from a combination of banding with nonselective beta blockers.
Secondary
prophylaxis: After an initial variceal bleed, the risk of a
second bleed is high and therapy is warranted to reduce the
risk of rebleeding. The options are similar to those for
primary prophylaxis.
|
|
 |
Video Endoscopic Sequence 3 of 19.
Endoscopic Variceal ligation
Cardias in retroflexed view, there are many varices with the red sign, meaning that a possible bleeding was near.
The combination of endoscopic therapy with medical therapy is the initial approach to prevent variceal rebleeding. Endoscopic banding is preferred to sclerotherapy because banding is associated with lower bleeding rates and fewer complications.
|
|
 |
Video Endoscopic Sequence 4 of 19.
Endoscopy of Variceal ligation
Red brillant varices of the cardias are appreciated at the lower portion of the esophagus. The proceeded to do the banding of these varices. It is important to notice that if we do not proceed aggressively when we find this sign, a possible bleeding from this varices may be presented shortly.
|
|
 |
Video Endoscopic Sequence 5 of 19.
Endoscopic variceal ligation (banding).
We can observe in the image and video the technique of banding of varices. We can see how the varix is suctioned and a rubber band is shot at the bottom. The patient complained from chest pain a day later.
|
|
 |
Video Endoscopic Sequence 6 of 19.
Banding of Esophageal Varices
Through the banding apparatus several varices can be seen at the cardias.
|
|
 |
Video Endoscopic Sequence 7 of 19.
Banding of Esophageal Varices
Another example of how the varix is succtioned and a band
its placed.
|
|
 |
Video Endoscopic Sequence 8 of 19.
Endoscopy of Variceal ligation
In this image and video we can observe another band placement and other varices already treated at the lower portion of the esophagus.
|
|
 |
Video Endoscopic Sequence 9 of 19.
Endoscopic Variceal ligation
The varices were successfully ligated.
In the video you can observe the varix with its
band. Other varices with bands can also be seen.
|
|
 |
Video Endoscopic Sequence 10 of 19.
The varix was successfully ligated.
You can observe the strangulated varix. Other varices with bands can be seen.
|
|
 |
Video Endoscopic Sequence 11 of 19.
Endoscopic Variceal ligation
The varices were successfully ligated.
|
|
 |
Video Endoscopic Sequence 12 of 19.
A follow-up 8 days later.
The varices shown signs of necrosis.
|
|
 |
Video Endoscopic Sequence 13 of 19.
We demostrate in this past sequence that banding of esophageal varices is an effective method. Showing minor or no complications.
It can be performed as the preferred method for prophylactic or therapeutical management of esophageal varices, especially when bleeding occurs.
|
|
 |
Video Endoscopic Sequence 14 of 19.
Gastric Cardias, retroflexed image, a necrotic ulceration of
the varix is observed.
|
|
 |
Video Endoscopic Sequence 15 of 19.
Five months later a new banding of the esophageal varices
was performed and 6 varices were ligated.
The image and the video clip display some scar of the
previous treatment.
|
|
 |
Video Endoscopic Sequence 16 of 19.
Some varices of the cardias in retroflexed image.
|
|
 |
Video Endoscopic Sequence 17 of 19.
The video clip displays a long tract of the esophagus
displaying multiple varices. |
|
|
Video Endoscopic Sequence 18 of 19.
Six varices were ligated at this time. |
|
 |
Video Endoscopic Sequence 19 of 19.
The image and the video display several scars are seen in this area of previous treatment and multiple varices were ligated..
Repeat banding is performed.
|
|
 |
Video Endoscopic Sequence 1 of 10.
This 62 year-old physician, with alcoholic cirrhosis presented his first bled due to esophageal varix, undergone variceal banding, six bands were placed.
|
|
 |
Video Endoscopic Sequence 2 of 10.
Large esophageal varices are seen.
|
|
 |
Video Endoscopic Sequence 3 of 10.
A banding apparatus was fitted to the end of the
endoscope.The image and video clip show the variceal
therapy with banding. |
|
 |
Video Endoscopic Sequence 4 of 10.
Varices with Banding Therapy.
|
|
 |
Video Endoscopic Sequence 5 of 10.
Eradication of the esophageal varices by endoscopic band ligation. Scars in the esophageal wall.
After 3 session with banding, most of the varices were irradicated, the image and the video clip shows the scars.
|
|
 |
Video Endoscopic Sequence 6 of 10.
Several scars are seen in this area.
Band ligation is now considered the first-line endoscopic therapy for esophageal varices. The band ligator is readily attached to the distal end of the endoscope, which is advanced to the varix; the endoscopist then suctions the varix into the ligator cap and deploys a rubber band around the varix. This results in the plication of the varices and surrounding submucosal tissue, with fibrosis and eventual obliteration of varices.
|
|
 |
Video Endoscopic Sequence 7 of 10.
After one week of the latest session of banding, patient presented with an upper bleeding that was due to the site of a varix that was falled off.
|
|
 |
Video Endoscopic Sequence 8 of 10.
In order to stop the hemorrhage, the argon plasma coagulator is used to coagulate the exact site of the bleed. |
|
 |
Video Endoscopic Sequence 9 of 10.
The blue light of the APC is seen.
The argon plasma coagulation (APC) is used to promote mucosal fibrosis and compared the efficacy of ligation plus APC with ligation alone in the treatment of esophageal varices.
|
|
 |
Video Endoscopic Sequence 10 of 10.
The final Status of the coagulation with Argon Plasma Coagulator, the hemorrhage has been stopped successfully. APC is theoretically well suited for mucosal fibrosis therapy, it can be used for the complete elimination of esophageal varices and for fibrosis of the distal esophageal mucosa.
This patient has had no further bleeding.
|
|
 |
Video Endoscopic Sequence 1 of 2.
Endoscopy of status post variceal banding
A 64-year-old female, ten days previous underwent an Endoscopic Variceal Ligation in another clinic and in another country due to a bleeding from the upper digestive tract, in our unit an upper endoscopy was performed and found this post-treatment status.
|
|
 |
Video Endoscopic Sequence 2 of 2.
Endoscopy of status post variceal banding
|
|
|
|
|
|
|
