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PTH-127 Endoscopic Variceal Band Ligation (EVBL) at The 37 Military Hospital, Accra-Ghana: Our Experience with The Euro-Ligator-Universal (Euro Multiband Ligator)
  1. R Robinson1,
  2. M Thomas1,
  3. M Norwood1,
  4. A Ntiri1,
  5. K-U Lat2,
  6. J Kpodo2,
  7. E Asumanu2,
  8. W Yevudza2,
  9. N Nuamah2
  1. 1Digestive Diseases Centre, University Hospitals of Leicester, Leicester, UK
  2. 2Department of Surgery, 37 Military Hospital, Accra, Ghana

Abstract

Introduction Bleeding gastro-eosophageal varices are the 3 rd commonest cause of UGI bleeding in Ghana and have a high mortality. EVBL is an effective, safe treatment for oesophageal varices but single use, preloaded ligators are unaffordable in developing countries. We report our early experience of the re-usable Euro-Ligator for variceal banding.

Methods The Euro-Ligator is the first re-usable multiple band ligator. It operates on a different principle to other ligators. A rotating driver is locked into the instrument channel and pre-loaded bands are deployed as an inner cylinder is withdrawn. Training in the use of the Euro-Ligator was provided by a visiting team from the University Hospitals of Leicester, funded by the British Society of Gastroenterology. During a one day course (October ‘15) the endoscopy team at 37 Military received instruction in loading the bands, intubation, band deployment and disinfection. An instruction video of each step was produced. During the course 5 patients were successfully banded under the supervision of the visiting team. Dedicated lists for variceal banding were established.

Results To date, 15 EVBL sessions have been performed on 7 patients (6 males, age range 16 to 62). In all, 60 bands have been deployed with a successful band deployment rate of 55/60 (91.6%). The mean number of bands used per session was 3.7. All procedures were elective day cases after an index bleed & performed under conscious sedation. No mortality was recorded during the procedures & all patients were discharged home the same day. We have not seen deep ulceration, perforation or aspiration pneumonia. One patient was lost to follow up after the index procedure and 1 patient died 2 weeks after the initial session from Hepatic Failure (Child Pugh C). In the remaining 5 patients under follow-up, haemostatic control has been achieved with no further bleeding episodes reported. Complete eradication has now been achieved in 1 patient.

Conclusion This preliminary case report gives us some insight and working experience into the use of the multiband Euro-Ligator. We found the equipment easy to use and technically effective in the endoscopic treatment of oesophageal varices. We need to adhere to stringent disinfection and cleaning protocols to ensure long term safety in our patients and evaluate the clinical and cost effectiveness over a longer period. However, the Euroligator is a major advance in the management of bleeding oesophageal varices in the developing world

Disclosure of Interest None Declared

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