Gastric variceal ligation: a new technique.

BACKGROUND: Gastric variceal bleeding is a serious complication of portal hypertension. The role of endoscopy in its management is still controversial. However, band ligation of gastric varices has not been evaluated. This study prospectively describes gastric variceal ligation as a new endoscopic technique for the management of different types of gastric varices.
METHODS: Gastric variceal ligation was performed in 27 patients with gastric varices: 3 patients had type 1 gastroesophageal varices, 14 had type 2, 8 had isolated gastric varices, and 2 had both type 1 and type 2 gastroesophageal varices. The etiology of portal hypertension was schistosomiasis in 9, post hepatic cirrhosis in 3, and mixed cirrhosis in 15 patients. The Child-Pugh classification was grade A in 6, B in 17, and C in 4 cases. Active variceal bleeding was present in 18 patients, whereas nonbleeding varices were encountered in 9 patients.
RESULTS: Emergency gastric variceal ligation arrested bleeding in 16 of 18 patients (88.8%). Recurrent bleeding was noted in 5 of 27 (18.5%). Six patients died (22.2%), 3 due to recurrent bleeding and 2 to liver failure. Variceal obliteration was achieved in all patients who underwent repeated elective sessions. The number of sessions needed for obliteration of varices was significantly less in patients with isolated gastric varices when compared with those with type 1 gastroesophageal varices ( p < 0.04). No serious complications occurred.
CONCLUSION: Gastric variceal ligation is a safe and effective treatment for the different types of gastric varices but especially isolated gastric varices.