Esophageal varicose veins are a disease of esophageal veins characterized by their tortuosity and expansion due to the development of phlebectasis. In most cases, the pathology is asymptomatic, manifested only with complications in the form of bleeding. Esophageal vein ligation is a procedure aimed at preventing bleeding. The operation eliminates the complication of pathology, an integrated approach is needed to treat varicose veins.
Esophageal varicose veins: classification
The pathology of the varicose system of the esophagus is formed due to increased pressure in the structure of the portal or vena cava. With increasing pressure, the outflow of blood is disturbed or its stagnation forms in the esophageal veins, which leads to the formation of varicose veins.
The effectiveness of the prescribed therapy depends on the correct diagnosis. In medical practice, esophageal varicose veins are classified according to severity. There are several types of systematization: NIEC (Italy), OMED, JRSPH (Japan), but all of them are based on the same features and there are minor differences in the classification.
- I stage. Pathology is detected only with endoscopic examination. There are single vein dilations in the distal esophagus of not more than 5 mm.
- II stage. It is characterized by tortuosity of the veins with their localization in the lower third of the food tube. The dimensions of the organ, as well as the thickness of its mucosa, are within normal limits.
- III stage. Pathological changes in the veins are pronounced. The vessels swell and expand into the cavity of the organ, which leads to its narrowing. With endoscopic examination, red spots are observed.
- IV stage. Many varicose nodes are formed in the form of clusters. This leads to a strong narrowing of the lumen of the esophagus, up to its closure. There is obstruction of the esophagus and the development of bleeding. Treatment of pathology at this stage is carried out including by ligation of the veins of the esophagus.
Factors affecting the development of pathology
In rare cases, the disease is congenital. But in most cases it is acquired and is formed for a number of reasons. Violation of blood flow and increased pressure, which leads to varicose veins of the esophagus, is associated with the following factors:
- Infectious lesions of the liver with changes in its parenchyma.
- Cirrhosis of the liver.
- Benign and malignant neoplasia in the liver.
- Pathological change (expansion) of the hepatic artery.
- Obstruction of the portal vein.
- A vascular disease characterized by the formation of blood clots inside the blood vessels.
- Hypertonic disease.
- Damage to the thyroid gland.
According to statistics, the most common pathology occurs in men older than 50 years.
Treatment methods
Depending on the stage of the disease, therapy is prescribed. The treatment is complex and under the obligatory supervision of doctors either in the department of gastroenterology or in surgery. The main task is to prevent bleeding.
Drug treatment
Even if during the diagnosis it becomes clear that one cannot do without surgery, the patient can not do without medications.
- Hemostatic preparations: Troxerutin, Curantil, Ascorutin.
- Preparations that reduce acidity: "Rennie", "Almagel", "Relzer".
- Vitamin K.
- Calcium preparations.
- Freshly frozen plasma.
Surgical Therapies
The use of such methods is considered much more effective compared to conservative treatment. Surgeons use the following techniques:
- Sclerosis of the veins of the esophagus is an endoscopic technique in which a sclerosant solution is introduced into the vein wall, which subsequently causes obliteration of the vessel.
- The transjugular bypass method is the application of a portocaval shunt in the middle of the hepatic and portal veins.
- Bandaging - the installation of small gum over the dilated veins.
- Devascularization is the removal of bleeding vessels.
- Endoscopic ligation of the veins of the esophagus - overlaying clips on the affected bleeding vessels. Clipping avoids the recurrence of bleeding.
What is ligation of the esophagus veins?
Such an operation is prescribed in the last stages of the pathology of the vessels of the gastrointestinal tract. Esophageal vein ligation is an endoscopic surgical operation in which the dilated veins of the esophagus are ligated using special elastic ligature rings (hence the name). It can be performed as planned or with an opening bleeding according to emergency indicators.
As a result of the procedure, the lumen of the veins narrows, they are anesthetized, blood stops flowing to the affected areas. During the operation, mechanical damage to the walls of the esophagus sometimes occurs. But the injuries are minor, and this is a fairly rare occurrence.
Indications and contraindications for the procedure
An indication for ligation of varicose veins of the esophagus is the prevention of primary and repeated bleeding. Also, an operation can be prescribed in the following conditions:
- III and IV stages of varicose veins of the esophagus.
- Progressive cirrhosis of the liver.
- Severe stages of hypertension.
Contraindications to surgical intervention are:
- Acute stages of cardiovascular disease.
- Serious cerebrovascular accident
- The period of exacerbation of any chronic diseases.
- Violation of the hemostatic system.
Preparation for surgery
Preparatory activities include various general laboratory tests and instrumental diagnostics.
Laboratory research:
- Clinical blood test.
- Analysis of urine.
- Biochemistry of urine.
- Coagulogram.
- HIV, antibodies to hepatitis.
Instrumental diagnostics:
- Transabdominal ultrasound of the abdominal organs.
- MRI of the liver.
- X-ray of the esophagus.
- Esophagogastroduodenoscopy. Using this procedure, a change in the mucous membrane is visualized, and how narrow the lumen of the esophagus and damage to various genesis are narrowed.
If it is necessary to carry out ligation of the veins of the esophagus with cirrhosis, then the conclusion of an infectious disease specialist and a hepatologist will be required. They, in turn, can prescribe additional tests.
If the pathology arose as a result of the hemostatic system, it is necessary to obtain a conclusion from a phlebologist.
Technology for ligation of varicose veins of the esophagus
The operation can be carried out both under local and general anesthesia. 12 hours before the procedure, meals should be completely excluded. Immediately before the intervention of the patient, they enema and give psycholeptics.
The patient lies on his left side and inserts a mouthpiece into his mouth. An endoscopist introduces an endoscope through the pharyngeal ring. A special nozzle on an esophagoscope allows you to visualize even the smallest changes on the mucosa.
The device is brought close to the affected vein and include a vacuum aspirator. A section of the vein is sucked into the nozzle, where a ligature (nylon or latex ring) is thrown onto it. At one time, throw from 3 to 10 rings. The ring thoroughly pulls the portion of the vessel, which leads to its desolation and "bonding". The operation lasts no more than an hour.
After operation
The patient is taken to the ward, even if local anesthesia was used. You can’t get up for several hours. Within a week after ligation of the veins of the esophagus, individual sections die and become covered with fibrin. Necrosized vascular tissue falls off and is excreted from the body naturally. At the place of disconnection, ulcers appear, which are scarred after 3 weeks.
The patient is discharged no earlier than a week after the procedure. This is due to the fact that it is during this period that various complications can occur. Possible negative consequences:
- Severe abdominal pain.
- Repeated bleeding.
- The development of the inflammatory process in place of the latex ring.
- An allergic reaction to ligature material.
- Violation of the swallowing process. A fairly rare phenomenon and is often associated with a psychological factor.
Rehabilitation period
After ligation of the dilated veins of the esophagus upon arrival home, the patient must strictly comply with all medical prescriptions. Otherwise, serious complications may develop.
The main condition for a speedy recovery is a diet. Starting from the second day, the patient is transferred to table No. 1. The food should be boiled and ground through a blender. The diet lasts about a month. Subsequently, the patient is transferred to table No. 5. For 3 years, it is not recommended to engage in sports and serious physical exertion. If the previous work does not allow this, you will have to change it. Surgical intervention does not imply the removal of an important organ, so disability is not prescribed after it.
Doctors advise visiting special sanatoriums with mineral waters. In addition, a special daily routine with procedures that facilitate rapid recovery is developed there.
You need to know that esophageal varicose veins are incurable. After the operation, all measures must be taken to prevent repeated bleeding.
Prevention
In order to avoid ligation of the veins of the esophagus with cirrhosis, it is necessary to take all measures to prevent and timely treat this disease. It should be regularly examined, go to the appointment with a hepatologist. Internal hemorrhages are very dangerous and often fatal. To avoid disastrous consequences, it should be examined by a gastroenterologist.
People prone to varicose veins should follow a special diet. Fried, spicy food should be excluded, food should be properly chewed. Dishes should not be too chilled or hot.
You should completely stop taking alcohol. It is impossible to lift weights, but also to lead a passive lifestyle is also extremely undesirable.
Surgery is an extreme, albeit effective, method of therapy. In order not to resort to its use, at the slightest abnormal manifestations it is necessary to visit a doctor.