Modified 'Barrel Only' Technique for Endoscopic Variceal Ligation: A Comparative Study

2015 International Journal of Contemporary Medical Research   unpublished
Endoscopic Variceal Ligation (EVL) is an established procedure in the management of acute variceal bleeding and in prophylaxis of variceal bleeding. In standard technique, ligator handle is used to pull trigger cord to apply EVL bands. Winding of trigger cord over the control handle is time consuming. In modified 'barrel only' method, loading catheter is passed directly into the biopsy channel through the rubber cap with flap on without using ligator handle. Bands are applied by pulling the
more » ... by pulling the trigger cord directly with hand. It is proposed that by avoiding the use of control handle, procedure time will reduce significantly without compromising efficacy. Aim of this study was to compare the procedure time in modified method and standard method for EVL. Material and Methods: Fifty patients with cirrhosis undergoing EVL were enrolled into modified method. Another 50 cirrhotic patients who were undergoing standard EVL acted as controls. Time duration was recorded from the point of introduction of loading catheter into biopsy channel till the endoscope was ready for EVL. Release of multiple bands on single trigger during each procedure was also noted. Results: Mean time taken to load the endoscope with banding device in modified method arm was 80.5 seconds (range 60-104 seconds) and 210 seconds (range 160-315 seconds) in standard method arm. On an average modified method saved 129.5 seconds per procedure. Release of multiple bands on single trigger happened 6 times in modified method arm and 5 times in standard method arm. Conclusion: Modified method for EVL is quicker and effective in ligating esophageal varices as compared to standard EVL method.