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Done band ligation for liver cirrhosis with esophageal varices. Have difficulty swallowing. Common?

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My father (Age 61) was diagnosed with stage A liver cirrhosis with large esophageal varices (Grade 3-4). His doctor advised band ligation of the varices to decrease the risk of bleeding. The first banding was done on 4th XXXXXXX After the procedure, he had minor discomfort in swallowing for a few days but felt totally normal after a week or so. The second banding was done on July 16th. Five EVL bands were applied. But this time, even after two weeks he is feeling some discomfort in swallowing. He says that he has to take small bites of food and with slightly large bites he feels the need to drink water to push it down. So although he is able to have his usual meals, it takes a longer time. He lives in Bihar and his doctor is in Delhi, so a quick follow-up visit is not possible. We are worried why this is happening.

•     Can you please tell us if it is common for patients undergoing banding to experience swallowing difficulty even after two-three weeks? His next visit with his doctor is on the 29th of Aug. Is it ok to wait and watch till then? Can he take any medicine to ease his problem?

•     His doctor says that he will require several sittings of banding but does not say exactly how many. In your opinion, how many rounds of banding is needed for grade 4 varices?

•     Can banding have any long term/ serious complications related to swallowing? His doctor has informed about bleeding risk but nothing apart from that.

Best Regards,
Posted Sun, 25 Aug 2013 in Digestion and Bowels
Answered by Dr. Poorna Chandra K.S 7 hours later
Hi XXXXXXX and thanks for the query
As you might already know banding is done to prevent bleeding from large varices. Varices are formed because blood flow through the liver faces more resistance and the varices offer a low resistance path. The idea of banding is to shift these low resistance vessels from the esophagus (where they have a higher risk of bleed) to aother areas like the back and anterior abdominal wall where they are better supported and less likely to bleed
Normally after banding, an ulcer develops which gradually heals. The fibrosis of healing obliterates the varices. During the process of ulceration and healing some amout of swallowing difficulty is expected. There is no defined time frame for this as the depth of ulceration varies. Idealy the bands have to be applied at different levels so as to avoid one circumferential areas of fibrosis and stricture formation
Ask your dad to have Syr Suralfate 10ml tid before food and the dysphagis sensation should gradually come down.
Ideally 2 -3 sessions of banding are sufficient to obliterate the varices but it varies with the degree of portal pressures.
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