Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Endoscopic variceal ligation

John S Goff, MD
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Endoscopic variceal ligation (EVL) was developed in an effort to find an effective means of treating esophageal varices endoscopically with fewer complications than endoscopic sclerotherapy (ES) [1-4]. The concept was based upon many years of experience treating hemorrhoids with rubber band ligation in patients with and without portal hypertension. EVL works by capturing all or part of a varix resulting in occlusion from thrombosis. The tissue then necroses and sloughs off in a few days to weeks, leaving a superficial mucosal ulceration, which rapidly heals. EVL avoids the use of sclerosant and thus eliminates the deep damage to the esophageal wall that occurs after ES. Collateral vessels near the cardia decrease after EVL and EVL may promote the development of deep gastric collaterals. These factors may also contribute to the effectiveness of EVL for preventing further variceal bleeding [5,6]. Another interesting finding is that during acute variceal bleeding, the hepatic venous pressure gradient (which correlates with the risk of variceal bleeding) increases after ES, but not after EVL [7].

The first patient was treated with EVL in 1986. Since then, advances in the technique have led to its routine use in the care of patients with esophageal varices. One of the biggest advances was the development of the multiple band ligator (Saeed Six-Shooter and Speedbander), which has simplified and improved the safety of EVL.

The technical considerations involved in EVL and the data supporting its technical efficacy will be reviewed here. The role of EVL in the care of patients with varices is discussed separately. (See "Methods to achieve hemostasis in patients with acute variceal hemorrhage" and "Prevention of recurrent variceal hemorrhage in patients with cirrhosis".)


Endoscopic variceal ligating devices are placed on the tip of standard endoscopes. The device has a soft sheath potion that fits over the tip of the endoscope and a hard plastic portion. Bands are stretched over the hard portion at the distal end of the device and later deployed onto the varices. Currently available devices are designed for standard and therapeutic sized endoscopes.

The procedure begins after a thorough upper endoscopy to identify the esophageal varices that are to be treated. Actively bleeding varices or those with stigmata indicating recent bleeding (such as a fibrin plug or a "red wale" sign) should be primary targets even if they are not located at the gastroesophageal junction (picture 1A-B). There are no absolute restrictions on coagulation parameters that preclude performing EVL, although in patients with active bleeding, attempts should be made to improve the coagulation status [8].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Nov 20, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Van Stiegmann G, Cambre T, Sun JH. A new endoscopic elastic band ligating device. Gastrointest Endosc 1986; 32:230.
  2. Stiegmann GV, Sun JH, Hammond WS. Results of experimental endoscopic esophageal varix ligation. Am Surg 1988; 54:105.
  3. Van Stiegmann G, Goff JS. Endoscopic esophageal varix ligation: preliminary clinical experience. Gastrointest Endosc 1988; 34:113.
  4. Stiegmann GV, Goff JS, Sun JH, et al. Endoscopic variceal ligation: an alternative to sclerotherapy. Gastrointest Endosc 1989; 35:431.
  5. Seno H, Konishi Y, Wada M, et al. Improvement of collateral vessels in the vicinity of gastric cardia after endoscopic variceal ligation therapy for esophageal varices. Clin Gastroenterol Hepatol 2004; 2:400.
  6. Wiechowska-Kozłowska A, Białek A, Raszeja-Wyszomirska J, et al. Ligation of oesophageal varices may increase formation of "deep" gastric collaterals. Hepatogastroenterology 2010; 57:262.
  7. Avgerinos A, Armonis A, Stefanidis G, et al. Sustained rise of portal pressure after sclerotherapy, but not band ligation, in acute variceal bleeding in cirrhosis. Hepatology 2004; 39:1623.
  8. Vieira da Rocha EC, D'Amico EA, Caldwell SH, et al. A prospective study of conventional and expanded coagulation indices in predicting ulcer bleeding after variceal band ligation. Clin Gastroenterol Hepatol 2009; 7:988.
  9. Stiegmann GV, Goff JS, Sun JH, et al. Technique and early clinical results of endoscopic variceal ligation (EVL). Surg Endosc 1989; 3:73.
  10. Berkelhammer C, Madhav G, Lyon S, Roberts J. "Pinch" injury during overtube placement in upper endoscopy. Gastrointest Endosc 1993; 39:186.
  11. Jones WF, Alhalel R, Bourke MJ, et al. Efficacy and safety of over the scope vs bougie assisted overtube introduction in upper endoscopy: A prospective, controlled, single blind trial (abstract). Gastrointest Endosc 1995; 41:322.
  12. Saeed ZA. The Saeed Six-Shooter: a prospective study of a new endoscopic multiple rubber-band ligator for the treatment of varices. Endoscopy 1996; 28:559.
  13. Ramirez FC, Colon VJ, Landan D, et al. The effects of the number of rubber bands placed at each endoscopic session upon variceal outcomes: a prospective, randomized study. Am J Gastroenterol 2007; 102:1372.
  14. Shibuya S, Takase Y, Chikamori F, et al. An improved endoscopic variceal ligation for esophageal and solitary gastric varices--three-O-band-shooter. Wiad Lek 1997; 50 Suppl 1 Pt 1:293.
  15. Sackmann M, Gerbes AL. Application of a multiple-band ligator in active variceal bleeding. Endoscopy 1996; 28:533.
  16. Jensen DM, Machicado G, Jutabha R, et al. A multishot, speedbander compared to single shot rubber band ligator for endoscopic hemostasis of canine gastric varices (abstract). Gastrointest Endosc 1995; 41:306.
  17. ASGE Technology Committee, Liu J, Petersen BT, et al. Endoscopic banding devices. Gastrointest Endosc 2008; 68:217.
  18. Stiegmann GV, Goff JS, Sun JH, Wilborn S. Endoscopic elastic band ligation for active variceal hemorrhage. Am Surg 1989; 55:124.
  19. Laine L. Management of actively bleeding esophageal varices. Gastrointest Endosc 1997; 46:83.
  20. Lo GH, Lai KH, Cheng JS, et al. Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices. Hepatology 1997; 25:1101.
  21. Stiegmann GV, Goff JS, Michaletz-Onody PA, et al. Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. N Engl J Med 1992; 326:1527.
  22. Laine L, el-Newihi HM, Migikovsky B, et al. Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices. Ann Intern Med 1993; 119:1.
  23. Lo GH, Lai KH, Cheng JS, et al. A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices. Hepatology 1995; 22:466.
  24. Sarin SK, Govil A, Jain AK, et al. Prospective randomized trial of endoscopic sclerotherapy versus variceal band ligation for esophageal varices: influence on gastropathy, gastric varices and variceal recurrence. J Hepatol 1997; 26:826.
  25. Hou MC, Lin HC, Kuo BI, et al. Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: a prospective randomized trial. Hepatology 1995; 21:1517.
  26. Gimson AE, Ramage JK, Panos MZ, et al. Randomised trial of variceal banding ligation versus injection sclerotherapy for bleeding oesophageal varices. Lancet 1993; 342:391.
  27. Chen CY, Chang TT, Lin CY, et al. Endoscopic variceal ligation versus conservative treatment for patients with hepatocellular carcinoma and bleeding esophageal varices. Gastrointest Endosc 1995; 42:535.
  28. Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med 1995; 123:280.
  29. Lopes CV, Pereira-Lima JC, Pereira-Lima LF, et al. The efficacy of endoscopic ligation for the prevention of variceal rebleeding in cirrhotic patients according to the hepatocellular function. Hepatogastroenterology 2004; 51:195.
  30. Chen WT, Lin CY, Sheen IS, et al. MELD score can predict early mortality in patients with rebleeding after band ligation for variceal bleeding. World J Gastroenterol 2011; 17:2120.
  31. de Souza AR, La Mura V, Reverter E, et al. Patients whose first episode of bleeding occurs while taking a β-blocker have high long-term risks of rebleeding and death. Clin Gastroenterol Hepatol 2012; 10:670.
  32. Thiele M, Krag A, Rohde U, Gluud LL. Meta-analysis: banding ligation and medical interventions for the prevention of rebleeding from oesophageal varices. Aliment Pharmacol Ther 2012; 35:1155.
  33. Masalaite L, Valantinas J, Stanaitis J. Endoscopic ultrasound findings predict the recurrence of esophageal varices after endoscopic band ligation: a prospective cohort study. Scand J Gastroenterol 2015; 50:1322.
  34. Mostafa EF, Mohammad AN. Incidence and predictors of rebleeding after band ligation of oesophageal varices. Arab J Gastroenterol 2014; 15:135.
  35. Yoshida H, Mamada Y, Taniai N, et al. A randomized control trial of bi-monthly versus bi-weekly endoscopic variceal ligation of esophageal varices. Am J Gastroenterol 2005; 100:2005.
  36. Baroncini D, Milandri GL, Borioni D, et al. A prospective randomized trial of sclerotherapy versus ligation in the elective treatment of bleeding esophageal varices. Endoscopy 1997; 29:235.
  37. Petrasch F, Grothaus J, Mössner J, et al. Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis. BMC Gastroenterol 2010; 10:5.
  38. Saeed ZA, Michaletz PA, Winchester CB, et al. Endoscopic variceal ligation in patients who have failed endoscopic sclerotherapy. Gastrointest Endosc 1990; 36:572.
  39. Branch-Elliman W, Perumalswami P, Factor SH, et al. Rates of recurrent variceal bleeding are low with modern esophageal banding strategies: a retrospective cohort study. Scand J Gastroenterol 2015; 50:1059.
  40. Garcia-Tsao G, Sanyal AJ, Grace ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46:922.
  41. Hwang JH, Shergill AK, Acosta RD, et al. The role of endoscopy in the management of variceal hemorrhage. Gastrointest Endosc 2014; 80:221.
  42. Lo GH, Lai KH, Chang CF, et al. Endoscopic injection sclerotherapy vs. endoscopic variceal ligation in arresting acute variceal bleeding for patients with advanced hepatocellular carcinoma. J Hepatol 1994; 21:1048.
  43. Avgerinos A, Armonis A, Manolakopoulos S, et al. Endoscopic sclerotherapy versus variceal ligation in the long-term management of patients with cirrhosis after variceal bleeding. A prospective randomized study. J Hepatol 1997; 26:1034.
  44. Amitrano L, Guardascione MA, Manguso F, et al. The effectiveness of current acute variceal bleed treatments in unselected cirrhotic patients: refining short-term prognosis and risk factors. Am J Gastroenterol 2012; 107:1872.
  45. Xu L, Ji F, Xu QW, Zhang MQ. Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation. World J Gastroenterol 2011; 17:3347.
  46. Cotton P. Combination therapies may speed healing, reduce rebleeding of esophageal varices. JAMA 1991; 266:187.
  47. de la Peña J, Rivero M, Sanchez E, et al. Variceal ligation compared with endoscopic sclerotherapy for variceal hemorrhage: prospective randomized trial. Gastrointest Endosc 1999; 49:417.
  48. Djurdjevic D, Janosevic S, Dapcevic B, et al. Combined ligation and sclerotherapy versus ligation alone for eradication of bleeding esophageal varices: a randomized and prospective trial. Endoscopy 1999; 31:286.
  49. Garg PK, Joshi YK, Tandon RK. Comparison of endoscopic variceal sclerotherapy with sequential endoscopic band ligation plus low-dose sclerotherapy for secondary prophylaxis of variceal hemorrhage: a prospective randomized study. Gastrointest Endosc 1999; 50:369.
  50. Hou MC, Chen WC, Lin HC, et al. A new "sandwich" method of combined endoscopic variceal ligation and sclerotherapy versus ligation alone in the treatment of esophageal variceal bleeding: a randomized trial. Gastrointest Endosc 2001; 53:572.
  51. Saeed ZA, Stiegmann GV, Ramirez FC, et al. Endoscopic variceal ligation is superior to combined ligation and sclerotherapy for esophageal varices: a multicenter prospective randomized trial. Hepatology 1997; 25:71.
  52. Lo GH, Lai KH, Cheng JS, et al. The additive effect of sclerotherapy to patients receiving repeated endoscopic variceal ligation: a prospective, randomized trial. Hepatology 1998; 28:391.
  53. Al Traif I, Fachartz FS, Al Jumah A, et al. Randomized trial of ligation versus combined ligation and sclerotherapy for bleeding esophageal varices. Gastrointest Endosc 1999; 50:1.
  54. Umehara M, Onda M, Tajiri T, et al. Sclerotherapy plus ligation versus ligation for the treatment of esophageal varices: a prospective randomized study. Gastrointest Endosc 1999; 50:7.
  55. Argonz J, Kravetz D, Suarez A, et al. Variceal band ligation and variceal band ligation plus sclerotherapy in the prevention of recurrent variceal bleeding in cirrhotic patients: a randomized, prospective and controlled trial. Gastrointest Endosc 2000; 51:157.
  56. Cheng YS, Pan S, Lien GS, et al. Adjuvant sclerotherapy after ligation for the treatment of esophageal varices: a prospective, randomized long-term study. Gastrointest Endosc 2001; 53:566.
  57. Nishikawa Y, Hosokawa Y, Doi T, et al. Simultaneous combination of endoscopic sclerotherapy and endoscopic ligation for esophageal varices. Gastrointest Endosc 1995; 42:358.
  58. Fujino MA, Nakamura T. Endoscopic evaluation of the therapeutic effect of endoscopic variceal ligation in combination with sclerotherapy for esophageal varices. Gastrointest Endosc 1998; 47:96.
  59. Koutsomanis D. Endoscopic variceal ligation combined with low-volume sclerotherapy: A controlled study. Hepatology 1992; 102:A835.
  60. Laine L, Stein C, Sharma V. Randomized comparison of ligation versus ligation plus sclerotherapy in patients with bleeding esophageal varices. Gastroenterology 1996; 110:529.
  61. Bhargava DK, Pokharna R. Endoscopic variceal ligation versus endoscopic variceal ligation and endoscopic sclerotherapy: a prospective randomized study. Am J Gastroenterol 1997; 92:950.
  62. Reveille RM, Goff JS, Stiegmann GV, et al. Combination endoscopic variceal ligation (EVL) and low-volume endoscopic sclerotherapy (ES) for bleeding esophageal varices: A faster route to eradication (abstract). Gastrointest Endosc 1991; 37:243.
  63. Jensen DM, Kovacs TO, Jutabha R, et al. Initial results of a randomized, prospective study of combination banding and sclerotherapy vs. sclerotherapy alone for hemostasis of bleeding esophagogastric varices (abstract). Gastrointest Endosc 1995; 41:351.
  64. El Khayat HR, Khamis AA. Comparative evaluation of combined endoscopic variceal ligation (EVL) together with low volume endoscopic sclerotherapy (ES) versus sclerotherapy or band ligation alone for bleeding oesophageal varices (abstract). Gastroenterology 1995; 108:1061.
  65. Iso Y, Kawanaka H, Tomikawa M, et al. Repeated injection sclerotherapy is preferable to combined therapy with variceal ligation to avoid recurrence of esophageal varices:--a prospective randomized trial. Hepatogastroenterology 1997; 44:467.
  66. Masumoto H, Toyonaga A, Oho K, et al. Ligation plus low-volume sclerotherapy for high-risk esophageal varices: comparisons with ligation therapy or sclerotherapy alone. J Gastroenterol 1998; 33:1.
  67. Jung IS, Cheon GJ, Ryu CB, et al. Comparison of endoscopic variceal ligation versus combined ligation and endoscopic argon plasma coagulation (APC) for esopahgeal varices (abstract). Gastrointest Endosc 2001; 53:AB119.
  68. Watanabe Y, Hiraishi H, Mitobe Y, et al. Treatment with argon plasma coagulation for residual esophageal varices after endoscopic variceal band ligation or sclerotherapy (abstract). Gastrointest Endosc 2001; :AB124.
  69. Okano H, Shiraki K, Inoue H, et al. Long-term follow-up of patients with liver cirrhosis after endoscopic esophageal varices ligation therapy: comparison with ethanol injection therapy. Hepatogastroenterology 2003; 50:2013.
  70. Arakaki Y, Murakami K, Takahashi K, et al. Clinical evaluation of combined endoscopic variceal ligation and sclerotherapy of gastric varices in liver cirrhosis. Endoscopy 2003; 35:940.
  71. Grgov S, Stamenković P. Does sclerotherapy of remnant little oesophageal varices after endoscopic ligation have impact on the reduction of recurrent varices? Prospective study. Srp Arh Celok Lek 2011; 139:328.
  72. Karsan HA, Morton SC, Shekelle PG, et al. Combination endoscopic band ligation and sclerotherapy compared with endoscopic band ligation alone for the secondary prophylaxis of esophageal variceal hemorrhage: a meta-analysis. Dig Dis Sci 2005; 50:399.
  73. Harras F, Sheta el S, Shehata M, et al. Endoscopic band ligation plus argon plasma coagulation versus scleroligation for eradication of esophageal varices. J Gastroenterol Hepatol 2010; 25:1058.
  74. Meirelles-Santos JO, Montes CG, Guerrazzi F, et al. Treatment of esophageal varices using band ligation followed by microwave coagulation (abstract). Gastrointest Endosc 2001; :53AB120.
  75. Cipolletta L, Bianco MA, Rotondano G, et al. Argon plasma coagulation prevents variceal recurrence after band ligation of esophageal varices: preliminary results of a prospective randomized trial. Gastrointest Endosc 2002; 56:467.
  76. Sarin SK. Long-term follow-up of gastric variceal sclerotherapy: an eleven-year experience. Gastrointest Endosc 1997; 46:8.
  77. Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc 1986; 32:264.
  78. Soehendra N, Nam VC, Grimm H, Kempeneers I. Endoscopic obliteration of large esophagogastric varices with bucrylate. Endoscopy 1986; 18:25.
  79. Williams SG, Peters RA, Westaby D. Thrombin--an effective treatment for gastric variceal haemorrhage. Gut 1994; 35:1287.
  80. Przemioslo RT, McNair A, Williams R. Thrombin is effective in arresting bleeding from gastric variceal hemorrhage. Dig Dis Sci 1999; 44:778.
  81. Lo GH, Lai KH, Cheng JS, et al. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology 2001; 33:1060.
  82. Young MF, Sanowski RA, Rasche R. Comparison and characterization of ulcerations induced by endoscopic ligation of esophageal varices versus endoscopic sclerotherapy. Gastrointest Endosc 1993; 39:119.
  83. Marks RD, Arnold MD, Baron TH. Gross and microscopic findings in the human esophagus after esophageal variceal band ligation: a postmortem analysis. Am J Gastroenterol 1993; 88:272.
  84. Rai RR, Nijhawan S, Singh G. Post-ligation stricture: a rare complication. Endoscopy 1996; 28:406.
  85. Goff JS, Reveille RM, Stiegmann GV. Three years experience with endoscopic variceal ligation for treatment of bleeding varices. Endoscopy 1992; 24:401.
  86. Schmitz RJ, Sharma P, Badr AS, et al. Incidence and management of esophageal stricture formation, ulcer bleeding, perforation, and massive hematoma formation from sclerotherapy versus band ligation. Am J Gastroenterol 2001; 96:437.
  87. Goff JS, Reveille RM, Van Stiegmann G. Endoscopic sclerotherapy versus endoscopic variceal ligation: esophageal symptoms, complications, and motility. Am J Gastroenterol 1988; 83:1240.
  88. Lo GH, Lai KH, Shen MT, Chang CF. A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices. Gastrointest Endosc 1994; 40:675.
  89. da Silveira Rohr MR, Siqueira ES, Brant CQ, et al. Prospective study of bacteremia rate after elastic band ligation and sclerotherapy of esophageal varices in patients with hepatosplenic schistosomiasis. Gastrointest Endosc 1997; 46:321.
  90. Maulaz EB, de Mattos AA, Pereira-Lima J, Dietz J. Bacteremia in cirrhotic patients submitted to endoscopic band ligation of esophageal varices. Arq Gastroenterol 2003; 40:166.
  91. Berner JS, Gaing AA, Sharma R, et al. Sequelae after esophageal variceal ligation and sclerotherapy: a prospective randomized study. Am J Gastroenterol 1994; 89:852.
  92. Nikoloff MA, Riley TR 3rd, Schreibman IR. Complete esophageal obstruction following endoscopic variceal ligation. Gastroenterol Hepatol (N Y) 2011; 7:557.
  93. Holderman WH, Etzkorn KP, Patel SA, et al. Endoscopic findings and overtube-related complications associated with esophageal variceal ligation. J Clin Gastroenterol 1995; 21:91.
  94. Dennert B, Ramirez FC, Sanowski RA. A prospective evaluation of the endoscopic spectrum of overtube-related esophageal mucosal injury. Gastrointest Endosc 1997; 45:134.
  95. Nijhawan S, Rai RR, Nepalia S, et al. Natural history of postligation ulcers. Am J Gastroenterol 1994; 89:2281.
  96. Vanbiervliet G, Giudicelli-Bornard S, Piche T, et al. Predictive factors of bleeding related to post-banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case-control study. Aliment Pharmacol Ther 2010; 32:225.
  97. Hou MC, Lin HC, Chen CH, et al. Changes in portal hypertensive gastropathy after endoscopic variceal sclerotherapy or ligation: an endoscopic observation. Gastrointest Endosc 1995; 42:139.
  98. Panés J, Bordas JM, Piqué JM, et al. Increased gastric mucosal perfusion in cirrhotic patients with portal hypertensive gastropathy. Gastroenterology 1992; 103:1875.
  99. Tayama C, Iwao T, Oho K, et al. Effect of large fundal varices on changes in gastric mucosal hemodynamics after endoscopic variceal ligation. Endoscopy 1998; 30:25.
  100. Lo GH, Liang HL, Lai KH, et al. The impact of endoscopic variceal ligation on the pressure of the portal venous system. J Hepatol 1996; 24:74.
  101. Yoshikawa I, Murata I, Nakano S, Otsuki M. Effects of endoscopic variceal ligation on portal hypertensive gastropathy and gastric mucosal blood flow. Am J Gastroenterol 1998; 93:71.
  102. Sarin SK, Shahi HM, Jain M, et al. The natural history of portal hypertensive gastropathy: influence of variceal eradication. Am J Gastroenterol 2000; 95:2888.
  103. Pereira-Lima JC, Zanette M, Lopes CV, de Mattos AA. The influence of endoscopic variceal ligation on the portal pressure gradient in cirrhotics. Hepatogastroenterology 2003; 50:102.
  104. Schoonbroodt D, Zipf A, Jung M. Local necrosis and fatal perforation of oesophagus after endoscopic ligation. Lancet 1994; 344:1365.
  105. Hou MC, Lin HC, Chang FY, et al. Oesophageal perforation following endoscopic variceal ligation and balloon tamponade. J Gastroenterol Hepatol 1994; 9:659.
  106. Vitte RL, Eugene C, Fingerhut A, et al. Fatal outcome following endoscopic fundal variceal ligation. Gastrointest Endosc 1996; 43:82.
  107. Tachibana I, Yoshikawa I, Sano Y, et al. A case of mesenteric venous thrombosis after endoscopic variceal band ligation. J Gastroenterol 1995; 30:254.
  108. Malpani NK, Somani AK, Vardhan V, Goyal VP. Inadvertent banding of laryngeal mucosa during endoscopic variceal band ligation. Indian J Gastroenterol 1997; 16:121.
  109. Nagamine N, Kaneko Y, Kumakura Y, et al. Occurrence of pyogenic meningitis during the course of endoscopic variceal ligation therapy. Gastrointest Endosc 1999; 49:110.
  110. Saltzman JR, Arora S. Complications of esophageal variceal band ligation. Gastrointest Endosc 1993; 39:185.
  111. Hoepffner N, Foerster E, Menzel J, et al. Severe complications arising from oesophageal varix ligation with the Stiegmann-Goff set. Endoscopy 1995; 27:345.
  112. Hou MC, Yen TC, Lin HC, et al. Sequential changes of esophageal motility after endoscopic injection sclerotherapy or variceal ligation for esophageal variceal bleeding: a scintigraphic study. Am J Gastroenterol 1997; 92:1875.
  113. Iida T, Shijo H, Yokoyama M, et al. Effects of endoscopic variceal ligation on oxygen transport and the arterial lactate levels in patients with cirrhosis. Am J Gastroenterol 1998; 93:1340.
  114. Debette S, Gauvrit JY, Desseaux G, et al. Paraplegia after ligation of esophageal varices. Neurology 2003; 60:879.
  115. Gralnek IM, Jensen DM, Kovacs TO, et al. The economic impact of esophageal variceal hemorrhage: cost-effectiveness implications of endoscopic therapy. Hepatology 1999; 29:44.
  116. Zargar SA, Javid G, Khan BA, et al. Endoscopic ligation vs. sclerotherapy in adults with extrahepatic portal venous obstruction: a prospective randomized study. Gastrointest Endosc 2005; 61:58.