FAQs on Gastroenterology/Gastrointestinal Surgery and Hepatology

Q- What Is Banding Therapy?

Ans- Banding Therapy

Banding is used to treat oesophageal varices which result from a condition called portal hypertension.

What is portal hypertension ?

Sometimes with liver disease, blood flow through the liver is restricted causing an increase in the blood
 pressure in and around the liver. This is called portal hypertension. This back pressure of blood can
 cause a network of enlarged, weak varicose veins to develop in the oesophagus or stomach. These
 are called varices. If one of these veins ruptures severe bleeding can occur resulting in vomiting
of blood or passing blood in the form of black stools. In patients who have fluid retention due to their liver
 disease, portal hypertension can result in a build up of fluid in the abdomen. This is called ascites.

How does banding work?

Banding is just one way to treat oesophageal varices. It involves a long, flexible tube with
 a light on the end (an endoscope) which is passed through your mouth into the stomach.
 The doctor can view the varices in the oesophagus and inserts a rubber band round each of
these varices. This stops the blood supply in these veins and they eventually disappear. This will
 not affect the normal blood supply to the oesophagus. The varices are extra veins that have
developed and we need to try to eradicate them, otherwise they may rupture and bleed.

Prior to the procedure

Banding is sometimes carried out as an 'emergency' to stop severe bleeding of varices.
However sometimes the procedure can be planned ahead of time to prevent the varices from bleeding.
 In this case, you will be admitted to a ward where blood samples will be taken.
 The procedure will be explained to you along with the potential risks and you will be
asked to sign a consent form. To allow a clear view, the stomach must be empty.
 You will therefore be asked not to have anything to eat or drink for at least 6 hours before the test.
 On the day of the banding you will be asked to change into a hospital gown. You will also have
 to remove any false teeth. A needle will be inserted into a vein in your arm. This is used for
 giving you sedation during the procedure.

During the Test

• Banding is usually carried out in the endoscopy unit and can take between 15-30 minutes.
•  You will be asked to lie on your left side and will be attached to monitors to measure
•  your heart rate and blood pressure.
• You may be given sedation through the needle in your arm which will make you drowsy
•  and relaxed. The back of your throat will be sprayed to numb the area. To keep your 
• mouth slightly open, a plastic mouthpiece will be gently placed between your teeth.
• The endoscope is then passed into the stomach. This can be a little uncomfortable but 
• is not painful and does not interfere with your breathing. Air is passed down the tube which
•  distends the stomach to allow the doctor to have a better view of the gullet. If you get 
• a lot of saliva in your mouth, this will be cleared using special suction equipment. The bands
•  are then placed around the varices. The air is then sucked out of the stomach and the
•  tube removed quickly and easily.
• Once the procedure is complete, the monitors are removed and you will be transferred
•  back to the ward.

After the procedure

Once back in the ward you should remain on bed rest until the sedation (if given) has worn off.
 During this time, nurses will monitor your blood pressure and pulse. You will be able to eat and
 drink once you are fully awake. However if you have had your throat sprayed, you cannot
 eat or drink until your swallowing reflex has returned - which takes between 1-2 hours.

You may have a sore throat for about 24 hours following the banding, You may also feel a
 little bloated with the air remaining in your stomach. These discomforts will pass. If the pain
is severe or persistent, you should inform the nursing staff.

Are there any possible complications ?

Banding is a safe procedure with a very low frequency of complications, but occasionally the
 following can occur :

• The banded areas can become scarred, causing a narrowing in your oesophagus and 
• discomfort when you swallow. At worst, this sensation can remain for several weeks,
•  but will resolve.
• Occasionally small ulcers can form in the oesophagus where the banding has been carried out.
•  These can be easily treated with prescribed medication.
• In a very few, rare cases the oesophagus can perforate during the procedure. This may 
• require an operation to reverse.

Follow up appointments

• To completely eradicate the varices, you may require several treatments of banding
•  (usually between 3-4), which will require admission to hospital. You will usually be allowed
•  to go home the same day, although occasionally you may need to stay in hospital overnight.
• Once the varices have been successfully treated, you will have an endoscopy every 6 
• months to 1 year. This is to check the varices have not returned. If varices have developed, 
• they will be banded again.
• It is important that you attend the banding and outpatients appointments. If the varices are
•  left untreated, they may burst and bleed. If you have any signs of bleeding (such as dark 
• stools or vomiting blood) you must inform your doctor immediately.