Banding of Oesophageal Varices

Banding of oesophageal varices, also known as endoscopic variceal ligation (EVL), is a procedure used to treat or prevent bleeding from enlarged veins (varices) in the oesophagus. These varices are often caused by portal hypertension, a complication of liver diseases like cirrhosis.

When Do I Need the Procedure

Patients typically need banding of oesophageal varices when they are at risk of or have experienced bleeding due to enlarged veins in the oesophagus. Here are common scenarios:

1. Active Bleeding: If varices rupture and cause life-threatening bleeding, banding is performed as an emergency procedure to stop the bleeding.
2. High Risk of Bleeding: Patients with large varices may undergo banding to prevent future bleeding episodes.
3. Recurrent Bleeding: For patients who have previously had bleeding from varices, banding helps reduce the risk of recurrence.

What Do I Expect

During banding of oesophageal varices, here’s what you can expect:

Preparation

• You may need to fast for several hours before the procedure.
• Sedation or local anaesthesia will be administered to ensure comfort.

Procedure

• A flexible endoscope with a camera is inserted through your mouth and guided down your oesophagus.
• The doctor uses suction to pull the varices into a specialized banding device.
• Tiny elastic bands are placed around the varices to cut off their blood supply, causing them to shrink over time and the elastic bands are absorbed by the body.
• The procedure typically takes 10–20 minutes and may require multiple sessions for complete treatment.

Post-Procedure

• You’ll be monitored for a short time to ensure there are no immediate complications.
• Mild chest discomfort or throat soreness is common but temporary.
• You may need follow-up appointments to monitor for recurrence or additional treatment.

After the Procedure

After banding of oesophageal varices, proper aftercare is crucial to prevent complications and ensure recovery. Here are some key guidelines:

Immediate Post-Procedure Care

• Rest & Recovery: Avoid strenuous activities for at least 24 hours. You may feel tired, so rest as needed.
• Swallowing Check: Before eating, sip cold water to ensure your swallowing reflex is normal.
• Dietary Adjustments: Start with soft foodsand avoid anything too hot, spicy, or rough-textured to prevent irritation.

Common Side Effects

• Sore Throat & Mild Chest Discomfort: These symptoms should resolve within 24-48 hours.
• Feeling of Something Stuck: This is normal and occurs due to the bands. It should disappear in 2-3 dayswhen the bands fall off.

Activity Restrictions

• No Driving or Operating Machinery: If sedation was used, avoid driving or handling machinery for 24 hours.
• No Heavy Lifting: Avoid lifting heavy objects or engaging in intense physical activity until cleared by your doctor.

When to Seek Medical Help

• Severe Pain: If pain persists despite medication, contact your doctor.
• Vomiting Blood or Black Stools: This could indicate bleeding and requires immediate medical attention.

Safety of the Procedure

Banding of oesophageal varices is generally considered a safe and effective procedure, especially when performed by experienced specialists. It is minimally invasive and has a high success rate in preventing and treating bleeding from varices.

Potential Risks

While complications are rare, they can include:

• Pain or Discomfort: Mild discomfort or sore throat after the procedure, discomfort in the chest.
• Ulcer Formation: The banded area may develop small ulcers, which usually heal on their own.
• Recurrence: Varices can reappear, requiring follow-up treatments.

Benefits

• Life-Saving: Prevents life-threatening bleeding from ruptured varices.
• Treats active bleeding from ruptured varices.
• Reduces the risk of future bleeding episodes.
• Minimally Invasive: No major surgery is required.
• Quick Recovery: Most patients can resume normal activities within a day or two.

Cost of the Procedure

• Banding of oesophageal varices is a hospital procedure, it is covered under most hospitalization plans.
• The procedure is also Medisave deductible. Most of the companies’ health benefits and private health insurances cover the cost of the procedure, which may extend to the private hospitals.
• The fee benchmarks on the procedure done in different hospitals can be found in the website of Ministry of Health Singapore.
• Before the endoscopic procedure, a detailed financial counselling will be done to help the patients understand the cost breakdown in the preferred hospital.
• Patients should also check with their insurance provider on the updated policy regulations before the procedure.