High risk and emergency hemostasis
Category III - these are veins that are ready to rupture or are already bleeding: ligation is performed urgently and aggressively, starting from the source/most threatening nodes; with active bleeding, a ring on the bleeding point stops it in 90%+ of cases. Management includes monitoring, vasoactive therapy (as indicated), prevention of hepatic encephalopathy, and a strict diet. Staged sessions every 2–4 weeks lead to eradication; TIPS and transplantation prospects with a hepatologist are discussed in parallel. Patients with cirrhosis receive a clear plan for lifelong endoscopic surveillance.
Indications
- varicose veins of the esophagus grade 2–3 with cirrhosis - primary prevention of bleeding;
- bleeding from varicose veins - secondary prevention (staged eradication);
- acute bleeding from the veins of the esophagus - emergency hemostasis;
- intolerance/insufficiency of beta blockers.
Why ligate veins?
Bleeding from varicose veins of the esophagus is the most serious complication of cirrhosis with high mortality; ligation with latex rings is the standard for preventing and stopping it: the nodes are thrombosed and replaced by a scar, the risk of bleeding is reduced by 3–4 times. Eradication is achieved in 2–4 stage sessions with an interval of 3–4 weeks; The price category reflects the volume of varicose veins and the number of rings. The procedure is combined with taking beta blockers and treating the underlying liver disease; EGD monitoring is for life.
