1-
Push the endoscope with the
band into the stomach, after that flush the bands with water to get rid of the
mucus that hinders your vision when banding the varices.
2-
Withdraw the scope very
slowly till you reach the lower esophageal sphincter, at this site you can see
the varices, then begin suction of varix.
3-
Make complete suction till
the field is filled with the suctioned varix. At that time, you can fire one or
two bands to be sure that the band is completely fitted in position.
4-
The first band is the most
important one, especially when the stomach is full of fluids, blood, or food as
any suction will let the gastric contents to be suctioned into the lower
esophagus obscuring the field of vision, but after the first band ligation this
band works as a barrier for the gastric contents
5-
Avoid flushing water into the esophagus (cleaning
for the secretions or food) for fear of aspiration as most patients are not
intubated.
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