A new technique of combined endoscopic sclerotherapy and ligation for variceal bleeding

Figure 1 Handle unit with trip wire and scope fastener. Injector was passed along the trip wire after making a small nick in the plastic covering (arrow) with a sharp blade.

Figure 2 Endoscope loaded with the ligating unit at its distal end. An injector was coming out from the cylinder of the ligating device though the working channel of the scope.

Figure 3 ESL using Speedband, Superview multiple band ligator (Boston Scientific Co. , Watertown, MA) and sclero-therapy needle. (A) EVL at least 5 cm or more proximal to gastroesopahgeal junction, (B) sclerotherapy 2 to 3 cm proximal to gastroesophageal junction on the same varix, (C) EVL on the injection site (arrow) and (D) proximal (large arrow) and distal (small arrow) EVL on the same varix.