A 62-year-old man who presented with a massive attack of hematemesis and melena (recurrent attacks despite regular follow-up for esophageal varices) was admitted to the endoscopy unit. The patient gives a history of coronary stents and clopidogrel 75m g therapy. The patient underwent upper digestive endoscopy. The scope revealed risky varices. Band ligation was done.
What will you do?
1- I will begin at the lower esophageal sphincter and ligate varices till I reach the riskiest varices, then ligate them.
2- I will do targeted therapy, and ligate the riskiest varices first, then ligate or not the other varices.
What is your opinion about the most protruding varices?
1- Naturally occurring.
2- Incomplete detachment of previously banded varices.