What is Endoscopic Variceal Ligation?
Endoscopic Variceal Ligation, or EVL, is a procedure used primarily to treat swollen, enlarged veins in the food pipe (esophagus), known as esophageal varices. Varices develop most commonly in people with advanced or chronic liver disease and portal hypertension.
During an Upper GIT Endoscopy, the doctor uses a specialised banding device to place small rubber bands around selected enlarged veins. The bands stop blood flow through the treated varices, allowing them to shrink. EVL can be used to control active variceal bleeding and to reduce the risk of future bleeding. The banding itself usually adds only a short amount of time to the endoscopic procedure.
Variceal Bleeding Can Be Life-Threatening
Esophageal varices can rupture and cause severe bleeding. In appropriate patients, EVL is an important treatment for controlling active bleeding, reducing the risk of recurrent bleeding, and managing high-risk varices before they bleed.
Controls Variceal Bleeding
If a varix has ruptured and is actively bleeding, EVL can be used as an important endoscopic treatment to control the bleeding.
Helps Prevent Rebleeding
If you have already experienced variceal bleeding, repeat EVL together with appropriate medical treatment can help reduce the risk of another episode.
Reduces Varices Over Time
Regular EVL sessions can progressively reduce the size of esophageal varices, with the goal of achieving variceal eradication.
How is EVL Performed?
EVL is performed through an Upper GIT Endoscopy. The doctor identifies the varices and applies one or more small rubber bands where treatment is required.
Upper GIT Endoscopy
The endoscope is used to examine the esophagus and upper gastrointestinal tract and assess the size and appearance of the varices.
Identify the Varices
The doctor identifies the varices that require treatment under direct endoscopic vision.
Rubber Band Ligation
A specialised banding device places small elastic rubber bands around selected varices, stopping blood flow through the treated veins.
Follow-Up Plan
Depending on the remaining varices and your clinical condition, your doctor will decide when repeat endoscopy and additional EVL sessions are needed.
EVL Can Be Performed Comfortably Under Sedation
EVL is performed as part of an Upper GIT Endoscopy, and sedation may be used according to your clinical condition and the endoscopy team’s protocol. Sedation can significantly reduce discomfort and anxiety during the procedure. The type and level of sedation will be determined by your clinical team.
What Happens After EVL?
After the procedure, you will be monitored in the recovery area. If sedation was used, you may feel sleepy for a while. Your clinical team will advise you when to start eating, resume medicines, and return to normal activities.
Mild Throat or Chest Discomfort
You may experience a mild sore throat or a sensation of something being stuck in your chest for a day or two. This usually improves gradually.
Liquid or Soft Diet
You may be advised to have liquids or soft foods for the first 24 hours, or for another period specified by your doctor, to allow the treated areas to settle.
Repeat EVL Sessions
Repeat sessions are often scheduled at intervals of approximately 2–4 weeks until the varices are adequately treated or eradicated. Your doctor will determine the appropriate interval.
Follow Your Doctor’s Instructions Carefully
You may be advised to avoid very hot, spicy, or hard foods for the first few days. Take your prescribed liver medicines and acid-reducing medicines as directed, and do not stop any medication without medical advice. Avoid strenuous activity and heavy lifting immediately after the procedure. If sedation was used, follow your discharge instructions regarding driving and other activities.
EVL Can Be a Life-Saving Endoscopic Treatment
Variceal bleeding can be a serious medical emergency. In appropriate patients, EVL is an effective endoscopic treatment for controlling bleeding and reducing the risk of future bleeding. The banding itself usually takes only a short time, and sedation can make the procedure much more comfortable. If your doctor has recommended EVL, completing the advised treatment and follow-up without unnecessary delay is an important step in protecting your health.