Is pain common after a gastro-varicose procedure? When doctors "band" varicose veins in the esophagus, is the patient usually sent home with pain medications?

R.

Varicose veins in the esophagus (known as varices) are similar to the varicose veins often seen in the legs. In short, they are twisted, dilated veins that develop because of increased pressure in the venous system.

In the esophagus, varices often stem from high pressures in the portal venous system, which are veins that normally drain into the liver from the intestinal tract. Increased pressure in the portal venous system is most often the result of cirrhosis in the liver. As the portal venous pressure goes up, the blood must be diverted to other veins, and is then channeled most commonly to varices in the esophagus.

Varices can also occur in the stomach and in the rectum, although less commonly. The problem that is often encountered with varices is their propensity to bleed. Bleeding occurs because of increased tension in the wall of the varices, leading to rupture. Bleeding varices are a dreaded complication of cirrhosis, with the death rate approaching 30 to 50 percent.

Patients with bleeding varices usually vomit blood and/or pass black stools. By the time they get medical help, they often have lost significant amounts of blood and have low blood pressure requiring resuscitation. The therapy for bleeding varices involves an upper endoscopy to pinpoint the site of bleeding, followed by injection of a solution to destroy the varices or, as you mentioned, variceal banding.

Banding involves using an endoscope to place a small, rubber band around a varicose vein. This effectively cuts off the blood flow, and, over the next several days, the rubber band and the tissue within it will spontaneously fall off. The esophagus lining at the site will slowly heal. Banding is very effective in eradicating varices, and it often is repeated at set intervals over weeks until all the varices have been obliterated.

The most common side effect after banding is difficulty swallowing. Some patients feel that food is becoming stuck in their esophagus. The reason for this is that the bands (as many as 12 may be placed at one session) take up space in the esophagus. Thus, food that passes by them may get held up temporarily. The gastroenterologist that performs the banding will usually inform the patient about the possibility of this occurring. Avoiding solid foods such as meat and chicken for the first couple of days after banding will help avoid this side effect.

On the other hand, pain is uncommon after a banding procedure, and medications for pain are not given routinely.