Suction is applied through the endoscope, and the band is released over the entrapped varix. The clear plastic cylinder of the variceal ligation device is seen attached to the end of the endoscope. The portal venous system, formed by the confluence of the superior mesenteric vein and the splenic vein drains the stomach, the large and small intestine, the pancreas, and the spleen. An important feature of this system is that a number of its tributaries also communicate with the systemic circulation. These include the intrinsic and extrinsic veins of the gastroesophageal junction; hemorrhoidal veins of the anal canal; paraumbilical veins and the recanalized falciform ligament; the splenic venous bed and the left renal vein; and the retroperitoneum. In portal hypertension, these venous collaterals dilate and allow portal venous blood to return to the systemic circulation. Clinically, the most significant collaterals are the intrinsic veins of the gastroesophageal junction, which are located close to the mucosal surface. They are the collaterals most likely to bleed when dilated because of increased blood flow.
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