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How to save cost for esophageal varices?

Patients with cirrhosis of the liver develop abnormally dilated blood vessels in esophagus. These are called esophageal varices. Blood vomiting may occur from the rupture of these varices, which may be fatal, so it is important to eradicate these varices. To achieve this, an elastic band device is used. This device, called a multiband ligator, allows the consecutive application of up to six rubber bands to the varices in one session without removing the endoscope. The device is attached to the tip of the endoscope. The scope is introduced into the food pipe and the varix is sucked into the banding chamber, which applies the rubber band. Band ligation of esophageal varices is now considered the endoscopic procedure of choice to prevent recurrent variceal hemorrhage and eradicate varices, for which it usually requires 3C4 sessions.

Endoscopic variceal ligation (EVL) is an expensive procedure, especially for patients from lower socioeconomic classes in developing countries.

This study, performed by a team lead by Dr. Zaigham Abbas, is described in a research article to be published on April 14, 2008 in the World Journal of Gastroenterology.

Dr. Zaigham Abbas and colleagues reloaded the multiband ligator originally used and used it for subsequent sessions on the same patient, instead of having a new multiband ligator for each session. After each session, all the accessories of the ligator were disinfected in glutaraldehyde solution by standard protocols. The band ligator was then reloaded with six hemorrhoidal bands. This method substantially reduces the costCthe whole procedure using the reloaded band ligator was 58 % of the cost had a new ligator been used. The band ligator was virtually free as only the cost of the rubber bands was charged. The rest of the expenses were related to the endoscopy and recovery.

Reloading the original multiband ligator for the follow-up sessions of patients undergoing variceal eradication is a cost effective procedure and may be recommended for developing countries.


Contact: Jing Zhu
World Journal of Gastroenterology

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