Bleeding from gastric varices greater than 2 cm in diameter represents a major limitation for endoscopic hemostasis. The endoscopic injection sclerotherapy (EIS)using conventional sclerosing agents is not satisfactory for the control of acute
bleeding
from gastric varices which have large diameter, fast blood flow and abundant collateral circulations. Endoscopic ligation using small rubber bands, known to be alternative to EIS, never obliterate large gastric varices greater than 2 cm in
diameter.
Obliteration therapy using Histoacryl (n-butyl-2-cyanoacrylate), known to be more satisfactory, has some drawback such as embolization, We performed endoscopic ligation using detachable snares and rubber bands in 22 patients who had recently
bleeding
from gastric varices larger than 2 cm in diameter. For ligation of gastric varices larger than 2 cm in diameter, the detachable snares were used, and then for ligation of adjacent small gastric varices, rubber bands were used. In seven patients
active
bleedings were noted at initial endoscopy; 6 of them were successfully controlled by endoscopic ligation using detachable snares and rubber bands, but one patient who was uncontrolled by it died from bleeding and multiple organ failure. In
remaining 15
patients, there were no active bleeding but red color signs on large gastric varices; all of them were successfully controlled by endoscopic ligation using detachable snares and rubber bands. Early rebleeding, following initial treatment,
occurred
in
two patients (9.5%). So overall hemostatic rate of endoscopic ligation using the detachable snares and the rubber bands was 86.4% (19/22). Varices were nearly eradicated in 18 (85.7%) of the 21 survivor by ligation of 1-3 detachable snares (mean,
1.3
snares) and 4-30 rubber bands (mean, 16.2 bands) in 2-6 sessions (mean, 3.2 sessions). During or after ligation, there were no serious comp0lications, except transient epigastric pain or discomfort in 14.7% and fever in 1.3%. These results
suggest
that
endoscopic ligation therapy with detachable snares and rubber bands is a safe and effective method for treatment of acute- bleeding of gastric varices, especially gastric varices larger than 2 cm in diameter, which can not be controlled by
conventional
sclerotherapy or variceal band ligation. (Kor J Gastrointest Endosc 15: 670~677, 1995)
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