Endoscopic Variceal Ligation (EVL)

What is Endoscopic Variceal Ligation (EVL)? 
  • It is a procedure in which an enlarged vein or a varix (the plural is varices) in the esophagus is tied off or ligated by a rubber band delivered via an endoscope. It is also called rubber band ligation.
  • Esophageal varices develop as a complication of a sustained increase in blood pressure in the liver (portal hypertension), most commonly found in cirrhosis. The major problem with Esophageal Varices is the risk of bleeding.
 What is the purpose?
  • To control or stop bleeding or to prevent re-bleeding. The success of the procedure is in the range of 90%.
 How to prepare for an EVL 
  • Preparation for EVL is fasting for 6-8 hours similar to performing a regular esophagogastroduodenoscopy (EGD). An intravenous line is placed to deliver sedation or other medications.
 How is the procedure performed?
  • The procedure is performed as in regular EGD. An accompanying device is inserted into the endoscope channel which allows the delivery of ligating rubber bands to the engorged varix. Number of banding depends on the varices seen and may average 4-6.
What are the alternative procedures?
  • Injection of chemical solution (sodium tetradecyl sulfate, sodium morrhuate, ethanolamine oleate & absolute alcohol) into the varices via the endoscope is also used to control bleeding. Choice is dependent usually on the availability of accessories and the preferences and expertise of the endoscopist.
What are the complications?
  • Complications associated with EVL include additional bleeding due to tearing additional varices, ulceration of the lining over the varices, perforation or tear of the esophagus and aspiration of blood or gastric juice into the lungs.

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