Patients with cirrhosis of the liver develop abnormally dilated blood vessels in esophagus. These are called esophageal varices. Blood vomiting may occur from the rupture of these varices, which may be fatal, so it is important to eradicate these varices. To achieve this, an elastic band device is used. This device, called a multiband ligator, allows the consecutive application of up to six rubber bands to the varices in one session without removing the endoscope. The device is attached to the tip of the endoscope. The scope is introduced into the food pipe and the varix is sucked into the banding chamber, which applies the rubber band. Band ligation of esophageal varices is now considered the endoscopic procedure of choice to prevent recurrent variceal hemorrhage and eradicate varices, for which it usually requires 3¨C4 sessions.
Endoscopic variceal ligation (EVL) is an expensive procedure, especially for patients from lower socioeconomic classes in developing countries.
This study, performed by a team lead by Dr. Zaigham Abbas, is described in a research article to be published on April 14, 2008 in the World Journal of Gastroenterology.
Dr. Zaigham Abbas and colleagues reloaded the multiband ligator originally used and used it for subsequent sessions on the same patient, instead of having a new multiband ligator for each session. After each session, all the accessories of the ligator were disinfected in glutaraldehyde solution by standard protocols. The band ligator was then reloaded with six hemorrhoidal bands. This method substantially reduces the cost¨Cthe whole procedure using the reloaded band ligator was 58 % of the cost had a new ligator been used. The band ligator was virtually free as only the cost of the rubber bands was charged. The rest of the expenses were related to the endoscopy and recovery.
Reloading the original multiband ligator for the follow-up sessions of patients undergoing variceal eradication is a cost effective procedure and may be recommended for developing countries.
Reference: Abbas Z, L Rizvi L, Ahmed US, Mumtaz K, Jafri W. Cost Saving by reloading multiband ligator for esophageal varices: a proposal for developing countries. World J Gastroenterol 2008; 14(14): 2222-2225 http://www.wjgnet.com/1007-9327/14/2222.asp
Correspondence to: Dr. Zaigham Abbas, The Aga Khan University Hospital Stadium Road, Karachi 74800, Pakistan. zaigham@akunet.o Telephone: +92-21-4930051 Fax: +92-21-4934294
About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection. It provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th of every month. The WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the title China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
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World Journal of Gastroenterology