Endoscopic ligation in the treatment of variceal bleeding

Bleeding from esophageal varices is a common complication of cirrhosis associated with significant mortality. Endoscopic screening is recommended in selected patients with selected risk factors. Over the last 20 years, EVL using the described technique has evolved into a readily available, effective and safe treatment for esophageal varices. Once varices are confirmed, prophylactic therapy with EVL, medical therapy, or both is warranted, which may reduce both bleeding and mortality. In the setting of acute hemorrhage, EVL has a similar and sometimes complementary role to ES. EVL has been shown to stop variceal bleeding effectively but has minimal or no impact on long-term survival. For secondary prophylaxis, EVL effectively prevents rebleeding and obliterates varices with a favorable safety profile, thus replacing ES as the endoscopic treatment of choice. Adverse events following EVL are uncommon but may contribute to morbidity in patients with severe liver disease or preexisting portal gastropathy. Gastric varices remain a therapeutic challenge since large, prospective studies are lacking and patients generally have severe liver disease unaffected by endoscopic interventions.