Variceal Ligation, Sclerotherapy, and Other Hemostatic Techniques for Varices and Other Lesions

Endoscopic therapy plays an important role in the management of gastroesophageal variceal hemorrhage. Band ligation is the preferred endoscopic modality for the treatment of acute esophageal variceal bleeding and for primary and secondary prophylaxis of esophageal varices. Endoscopic sclerotherapy is associated with a higher rate of complications than variceal ligation, and its role is limited to the control of active bleeding when band ligation is technically difficult or fails. Cyanoacrylate injection is the endoscopic treatment of choice for bleeding fundal varices since band ligation and sclerotherapy are associated with high rebleeding rates. Endoscopic therapy is not effective for bleeding portal hypertensive gastropathy, but can be beneficial for gastric vascular ectasia. For the latter, argon plasma coagulation is considered first-line therapy, but cryotherapy and band ligation are promising alternative treatment modalities.