Acute Variceal Bleeding - Blood Emerging into the Banding Apparatus, Part 1

The image and the video display active variceal bleeding that is appreciated through the banding apparatus. Emergency endoscopic therapy requires a skilled endoscopist. Banding ligation was first reported in humans in 1989 and represents an important development in the endoscopic treatment of varices. Since its introduction, endoscopic variceal banding has been shown to be superior to needle sclerotherapy. It consists of the placement of rubber O-rings on variceal columns, which are sucked into a hollow cylinder attached to the tip of the endoscope. In the acute situation, hemostasis is achieved by physical constriction of the varix at or near the bleeding site, thus interrupting blood flow. In the following days, ischemic necrosis of mucosa and submucosa develops, followed by granulation tissue formation and sloughing of the O-rings and of the necrotic tissue, which leave shallow mucosal ulcerations. Complete reepithelialization takes place in 14-21 days, with full-thickness replacement of the vascular structures with maturing scar tissue.