Brief introduction of endoscopic variceal ligation

Directory 1 Pinyin 2 English Reference 3 Overview 4 Operation Name 5 Endoscopic Ligation Alias 6 Endoscopic Ligation Indications 7 Endoscopic Ligation Contraindications 8 Preparation 9 Methods 10 Precautions 1 Pinyin nè i j ì ng xi à shí gu m: Nj ì ng mà i q ǔ zhā ng t à o zhā sh ǐ.

2 English reference endoscopic esophageal allergy, EVL.

3. Summarize endoscopic variceal ligation (EVL), which is similar to rubber band ligation for hemorrhoids. EVL is a safe, effective and simple method to treat esophageal variceal bleeding.

The experimental study found that acute inflammatory reaction occurred within 1 ~ 4 days after the ligation of the skin ring, and local necrosis turned into scab peeling in 3 ~ 7 days, leaving superficial ulcers. Histological studies showed that submucosal inflammation and scar formation and submucosal varicose veins disappeared. Clinical research shows that superficial ulcers appear in all treatment sites after esophageal variceal ligation. 14 ~ 2 1 day after gastroscopy, the ulcer healed and varicose veins disappeared. Serious complications such as bleeding and perforation rarely occur.

Name of operation Endoscopic ligation of esophageal varices

5. Endoscopic variceal ligation alias EVL.

Indications Endoscopic variceal ligation is suitable for:

1. Esophageal varices and/or gastric varices bleeding or drugs are ineffective for hemostasis;

2. Repeated bleeding of esophageal varices, generally in poor condition, can not tolerate surgical treatment;

3. Selective prevention

Contraindications: severe heart, lung, brain and renal insufficiency, massive hemorrhage, hemorrhagic shock not corrected, or poor general condition, unable to cooperate and tolerate.

8 Prepare 1. Equipment preparation

(1) endoscope: forward-looking optical fiber or electronic endoscope is used, and the clamp channel should be greater than or equal to 2.8 mm ..

(2) Ligator: domestic ligator or imported ligator.

Installation of domestic ligator: ① Install the rubber band on the inner ring, and make the rubber band around the front edge of the inner ring about 0.05 mm with a conical installer. (2) Install the inner ring with skirt into the front edge of the outer cover. (3) The operating wire is sent out of the endoscope front end from the endoscope clamp channel and connected to the protruding gap of the inner ring (the length of the operating wire is about 140cm and the diameter is 0.75mm). ④ Connect the cover to the end of the endoscope, and tighten the operating wire (the cover is a transparent tube, and the field of vision of the endoscope is reduced by about 30% after installation). In recent years, it is more convenient to install foreign ligators, which can ligate 5 ~ 6 places at a time, and an apron has been installed, which can be operated after simple connection (Figure 1).

(3) Endoscope jacket and special big mouth pad.

2. Patient preparation

(1) is the same as the preparation before gastroscopy.

(2) intramuscular injection of diazepam 10 mg and 6542 10mg or 20mg of antispasmodic agent before operation.

(3) Routine gastroscopy should be performed first to understand the situation of esophagus, stomach and duodenum, so as to avoid the influence of the decrease of visual field after the ligation device is installed.

9 method 1. Indwelling endoscope cannula? This method is the same as the indwelling of STEI tube in esophageal variceal sclerosis treatment (EIS). Because the household ligation device can only install one ligation ring at a time, it avoids the damage to the pharynx caused by the repeated entry and exit of the endoscope after the outer sleeve of the endoscope is retained.

2. Install a ligation device at the front end of the endoscope (see instrument preparation).

3. Varicose ligation? After installing the ligator, insert the endoscope to find the lesion, determine the ligation position and sequence, align the outer cover with the ligation position, continuously suck the tissue into the outer cover cavity, pull the surgical steel wire rubber band off and tie it at the root of the lesion. At this time, we can see that the local part of the ligated vein is purple polypoid, and several parts are ligated repeatedly.

10 Precautions Pay attention to complications and prevention.

1. Bleeding? The main cause of bleeding is incomplete aspiration or ligation after aspiration, so the vein should be ligated again.

2. Difficulty swallowing? Dysphagia caused by EVL is usually short-lived, lasting less than 24 hours, and does not require special treatment.

3. The application of overtube may lead to bleeding or esophageal perforation, which should be paid attention to.