Endoscopic image of esophageal varices

Esophageal varices cause many very serious complications, can be fatal, and is common in patients with cirrhosis. Esophageal endoscopy allows the diagnosis of rupture risk and treatment of varicose veins in order to provide emergency treatment and reduce the risk of recurrence.

Esophageal varices is a condition in which the veins in the esophagus become dilated, usually in people with severe liver disease. Esophageal varices develop when normal blood flow to the liver is blocked by a blood clot or scarring in the liver.
To get around the blockage, blood flows into smaller blood vessels that are not designed to circulate large volumes of blood resulting in blood vessels that can leak or even burst, causing bleeding and threat live. When bleeding occurs, the risk of subsequent bleeding increases, until too much blood is lost, the patient can go into shock and at risk of death.

Causes of esophageal varices include:
Due to severe cirrhosis caused by some liver diseases such as: Hepatitis, alcoholic liver disease, fatty liver disease and cholestatic cirrhosis. Parasitic infection: Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Middle East, and Southeast Asia. This parasite can damage the liver, lungs, intestines, and bladder. Blood clots in the portal vein or in the veins that drain into the portal vein can cause esophageal varices. Esophageal varices often have the following signs, symptoms and manifestations:
Vomiting and blood in the vomit; Black excrement; Being stunned; Loss of consciousness in severe cases; Jaundice, yellow eyes, easy bleeding or bruising, ascites.

Esophageal varices cause many complications and is more dangerous than can be fatal. Endoscopic method of esophageal varices allows to diagnose the risk of rupture and treat varicose veins in order to provide emergency treatment and reduce the risk of recurrence. So when is endoscopic varices of the esophagus needed? Accordingly, in the following cases, esophageal varices need to be endoscopically:
Patients with grade II, III esophageal varices, red marks, no bleeding. Prevention of gastrointestinal bleeding due to primary or secondary esophageal varices. Endoscopy of esophageal varices is not recommended in the following cases:
Massive bleeding Severe coagulopathy The patient is showing signs of severe and progressive liver failure.

Step 1: Ask the patient to fast for 8-12 hours before the procedure Step 2: Check the indications and contraindications and check the tests Step 3: Prepare equipment - tools include: Endoscope stomach , procedure channel 2.8mm; Wilson Cook's multi-ring set. Step 4: Anesthetize the oropharynx with 2% Xylocaine; remove dentures (if any), remove nasogastric tubes; Place a gag to protect the scope and ask the patient to lie on the left side. Step 5: Insert the instrument (Six shooter): attach the handwheel to the biopsy channel and then insert the catheter through the white valve. When the catheter protrudes from the tip of the bronchoscope, tether the wire rope to the hook, then pull the catheter back out, carrying the wire. After the tow rope has come out of the white valve piece, insert the top end of the cord into the swivel groove on the handwheel and rotate until the rope is taut, then at the bottom end, attach the hood with the rubber rings tightly to the end of the scope. Hold the handwheel in the one-way rotation only position. Step 6: Place the active server under the monitor's control to avoid scratching the pharynx and glottis. Observe to count the number of columns and find a suitable ligation position (usually right above the cardia, avoid ligation where there is fibrous scar, ulcerated tissue, too small dilation because it will not be effective). Proceed in turn clockwise and from low to high when deciding to tie multiple places. Step 7: After selecting the ligation, control the scope so that the intended ligation is at the 12 o'clock position. Raise the Up lever to bring the bronchoscope nearly perpendicular to the dilated tuft. Press the button to suck, the stretchy bun will enter the hood. When the tuft is very large, it will no longer be visible, but only a faint red color, then start turning the crank to release the loop. After tying 1 tie, the next can be tied by turning the machine to bring the next pole at 12 o'clock and tie as before.

After endoscopic esophageal varices, based on endoscopic images of esophageal varices, the following cases occur:
There is definitely rupture of esophageal varices: When there is a jet of blood ejected from the vein. oesophagus or oozing spots on the wall of the esophageal veins. Possible rupture of esophageal veins: There is a clot that has turned ivory white or a new clot is stuck on the wall of the vein, which does not fall off during irrigation. Possibly ruptured esophageal varices: Large, bloody esophageal varices in the stomach in the absence of other associated gastric or esophageal varices bleed readily with gentle irrigation.

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MORE:
Common problems in the esophagus Esophageal varices: Causes, symptoms, diagnosis and treatment of esophageal varices in patients with cirrhosis