Controlling Oesophageal Variceal Bleeding by Reloading Inexpensive Haemorrhoidal O-Rings for Band Ligation

Abstract

Background: Gastrointestinal endoscopy plays the most important role in diagnosis and treatment of patients with upper gastrointestinal bleeding. Improvements in management of variceal haemorrhage have been reported from Europe and North America. The management of this disorder in our setting has been largely supportive due to prohibitive costs of the kits required for ligation. Data on the experience from a hospital in Nigeria, using a cheap device is presented in this report.
Patients and Methods: This study was carried out at the Endoscopy Unit of Evangel hospital, Jos between 2004 and 2007. All patients had presented with haematemesis and or melaena. A special reloading kit (produced by McGown; USA) was used to reload previously used and sterilized Opti-vu caps from Saeed six shooter variceal band ligators (North Carolina, USA). Subjects with oesophageal varices underwent banding of the varices down the lower 5cm of the oesophagus using this technique. These sessions were repeated till the varices were obliterated or the patients were lost to follow up or dead. Analyses of the data obtained were performed using EPI Info 2004 version 3.3.2 (Atlanta GA, USA).
Results: Ninety-two patients were diagnosed to have oesophageal varices during the period of study. Of these, seventy-two (78.2%) underwent initial oesophageal variceal band ligation. Only 40 follow up records, representing 55.5% of those that had initial band ligation were available for analysis. All 40 patients, except three turned up for repeat gastroscopies. These sessions range from 1-7 with a mean of 2 sessions in order to obliterate the varices. There were two cases of rebleeding following an initial banding. Thirty-one (77.5%) of these patients made satisfactory recovery, 6 did not require a subsequent banding at second gastroscopy, and one patient died due to liver failure before he could have a recheck gastroscopy. Follow up banding sessions (using “O” rings reloaded opti-vu caps) were associated with loss of some of the bands in 12 cases and breaking of the opti-vu cap during unloading in five cases. The data had poor follow up documentation and thus records were not detailed enough to capture overall mortality in the study population. Conclusion: Oesophageal variceal band ligation using cheap reloadable haemorrhoidal O rings is a safe procedure with low morbidity associated with variceal bleeding in resource-limited settings.

Keywords: Oesophageal Varices, Bleeding, Band Ligation, Re-use, Nigeria, Evangel Hospital, Cirrhosis