Image Based Question-72009

The patient is a 46-year-old man with a history of hepatitis C, who presented with haematemesis. Following procedure was done as shown in the image.Identify this procedure.

A. Oesophageal transection

B. Endoscopic Balloon Tamponade

C. Sclerotherapy

D. Banding of esophageal varices

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Correct Answer » D Explanation

Ans:D. Banding of esophageal varices.

ESOPHAGEAL VARICES

• Emergency gastroscopy and banding of esophageal varices (blue rubber bands) procedure is shown in the image.

• Most common cause of this condition: Cirrhosis (alcohol and hepatitis B or C).

• Factors predictive of bleeding: Size of varices (directly proportionate to the vessel wall tension), red wheal markings on the varices (from decreased wall thickness), severity of liver disease and persistent alcohol abuse.

• Bleeding can be stopped by Injection sclerotherapy or balloon tamponade using a Sengstaken Blakemore tube.

• 70% of patients re-bleed within the first year. Beta-blockers reduce this risk by half. With variceal treatment, the incidence is reduced by a further half.

• Other options which can be considered if endoscopic treatments fail:Transjugular Intrahepatic Portosystemic Shunting (TIPS), surgical shunt (partial/selective) or oesophageal transection.