EVL (Banding)
Endoscopic Variceal Ligation (EVL), also known as variceal banding, is a medical procedure used to treat esophageal varices—abnormally dilated blood vessels in the esophagus that can occur as a result of portal hypertension, often due to liver cirrhosis. These varices are prone to rupture, which can lead to life-threatening bleeding. EVL is a key intervention to prevent and control variceal hemorrhage.
During the EVL procedure, an endoscope (a long, flexible tube with a camera) is inserted through the mouth into the esophagus to visualize the varices. A specialized device, typically an endoscopic banding tool, is then used to place rubber bands around the varices. These bands constrict the blood vessels, cutting off their blood supply. This causes the varices to shrivel and eventually slough off, reducing the risk of bleeding.
The procedure is typically performed under local anesthesia or conscious sedation, allowing for minimal discomfort to the patient. EVL is usually repeated at intervals until the varices are effectively treated. It is considered a safe and effective method for managing variceal bleeding and preventing recurrence, especially in patients with cirrhosis or portal hypertension.
The primary indications for EVL include:
- Primary prophylaxis: Preventing variceal bleeding in patients with high-risk esophageal varices.
- Secondary prophylaxis: Reducing the risk of re-bleeding in patients who have already experienced variceal hemorrhage.
- Acute variceal bleeding: Emergency management of active bleeding from esophageal varices.
While EVL is highly effective, it may have side effects, such as chest discomfort, dysphagia (difficulty swallowing), or in rare cases, esophageal perforation. Regular follow-up and monitoring are required to ensure that the varices do not recur and that the procedure remains successful.
