El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Post variceal ligation hemorrhage This 65 year old female, that had 3 episodes of gastrointestinal bleeding due to esophageal varices. At endoscopy multiple varices with the red spot sign are seen. The red color sign observed by endoscopic examination is a reliable predictive factor for variceal bleeding.

Video Endoscopic Sequence 1 of 17.

 Post variceal ligation hemorrhage

 This 65 year old female that previously had 3 episodes of
 gastrointestinal bleeding due to esophageal varices.
 At endoscopy multiple varices with the red spot sign are
 seen.
 The red color sign observed by endoscopic examination is a
 reliable predictive factor for variceal bleeding.

 
Presence of multiple cherry red spots. Endoscopic signs of esophageal varices and platelet count were significant predictors for the appearance of the red color sign.

Video Endoscopic Sequence 2 of 17.

Endoscopy shows Presence of multiple cherry red spots.

 Endoscopic signs of esophageal varices and platelet count
 were significant predictors for the appearance of the red
 color sign.

 Variceal appearance on endoscopy ("red signs")

  • Red wale marks (longitudinal red streaks on varices)
  • Cherry-red spots (red, discrete, flat spots on varices)
  • Hematocystic spots (red, discrete, raised spots)
  • Diffuse erythema.
Banding of Esophageal Varices. The varix is aspirated into the banding chamber, and a trip wire dislodges a rubber band carried on the banding chamber, ligating the entrapped varix. One to three bands are applied to each varix, resulting in thrombosis. Band ligation eradicates esophageal varices with fewer treatment sessions and complications than sclerotherapy.

Video Endoscopic Sequence 3 of 17.

Banding of Esophageal Varices.

 The varix is aspirated into the banding chamber, and a trip
 wire dislodges a rubber band carried on the banding
 chamber, ligating the entrapped varix. One to three bands
 are applied to each varix, resulting in thrombosis. Band
 ligation eradicates esophageal varices with fewer
 treatment sessions and complications than sclerotherapy.           

Endoscopic view of Banding of Esophageal Varices. Endoscopic variceal ligation has evolved to be the preferred first line modality for the endoscopic treatment of esophageal variceal bleeding.

Video Endoscopic Sequence 4 of 17.

Endoscopic view of Banding of Esophageal Varices.

 Endoscopic variceal ligation has evolved to be the
 preferred first line modality for the endoscopic treatment
 of esophageal variceal bleeding.

 
The varices with with the red spot were ligated.

Video Endoscopic Sequence 5 of 17.

 Endoscopy of Variceal Banding

 In this image and the video clip shows that the varices with
 the red spot were ligated.
This picture as well as the video clip display some varices with the red sign that were ligated.

Video Endoscopic Sequence 6 of 17.

This picture as well as the video clip display some varices with the red sign that were ligated.
Endoscopic variceal ligation is safer and more efficacious than sclerotherapy as initial treatment of bleeding esophageal varices, whereas cyanoacrylate injection is the endoscopic treatment of choice for gastric varices. Despite advances in the treatment of variceal bleeding, liver function remains the determining factor of patient survival. Liver transplantation is the only definitive treatment that can alter the course of the disease.

Video Endoscopic Sequence 7 of 17.

 Endoscopic variceal ligation is safer and more efficacious
 than sclerotherapy as initial treatment of bleeding
 esophageal varices, whereas cyanoacrylate injection is the
 endoscopic treatment of choice for gastric varices.

 Despite advances in the treatment of variceal bleeding,
 liver function remains the determining factor of patient
 survival. Liver transplantation is the only definitive
 treatment that can alter the course of the disease.

Video Endoscopic Sequence 8 of 17.

 
Acute Variceal Bleed Six days after the varices were strangulated, patient initiated with hematemesis, an emergency endoscopy was performed. to determine the source of bleeding .

Video Endoscopic Sequence 9 of 17.

 Acute Variceal Bleed

 Six days after the varices were strangulated, patient
 initiated with hematemesis, an emergency endoscopy was
 performed to determine the source of the bleeding.
There are two possible sites of the bleeding of two varices that were previously ligated, hemostatic maneuver has been applied with APC.

Video Endoscopic Sequence 10 of 17.

 There are two possible sites of the bleeding two varices
 that were previously ligated, hemostatic maneuver
 has been applied with APC.         
There are a varix with a blood clot in front of the previous one, give us the suspicion of being another site of bled.

Video Endoscopic Sequence 11 of 17.

 There are a varix with a blood clot in front of the previous
 one, give us the suspicion of being another site of bled.

Video Endoscopic Sequence 12 of 17.

 
More hemostatic maneuver with APC.

Video Endoscopic Sequence 13 of 17.

More hemostatic maneuver with APC.
The light produced by the APC is observed.

Video Endoscopic Sequence 14 of 17.

 The light produced by the APC is observed.

 
Endoscopic ligation of esophageal varices combined with APC is superior to ligation alone. Since APC is theoretically well suited for mucosal fibrosis therapy, it can be used for the complete elimination of esophageal varices and for fibrosis of the distal esophageal mucosa.

Video Endoscopic Sequence 15 of 17.

 Endoscopic ligation of esophageal varices combined with
 APC is superior to ligation alone. Since APC is
 theoretically well suited for mucosal fibrosis therapy, it can
 be used for the complete elimination of esophageal varices
 and for fibrosis of the distal esophageal mucosa.
 

 
The site of the bleeding was re- ligated with rubber bands in spite of previous ligated, six day ago. The hemorrhage was stopped.

Video Endoscopic Sequence 16 of 17.

 The site of the bleeding was re- ligated with rubber bands
 in spite of previous ligated, six day ago. The hemorrhage
 was stopped.

 
This image and the video clips show the status post hemostatic maneuvers that have been performed.

Video Endoscopic Sequence 17 of 17.

 This image and the video clips show the status post
 hemostatic maneuvers that have been performed. 

 
This 33 year-old male with alcoholic cirrhosis since two years previously underwent rubber bands due to multiple variceal bleeding carrying out three treatments with rubber bands.This one is the fourth episode, this morning started with two episodes of melena, in spite of his disease the patient has continued with his alcoholism. Endoscopy was performed under conscious sedation.

Video Endoscopic Sequence 1 of 10.

Endoscopy of

Fibrosis due to a Status post banding and variceal hemorrhage due to a varix of the esophagus

 This 33 year-old male with alcoholic cirrhosis since two
 years previously underwent rubber bands due to multiple
 variceal bleeding carrying out three treatments with rubber
 bands. This one is the fourth episode, this morning started
 with two episodes of melena, in spite of his disease the
 patient has continued with his alcoholism. Endoscopy was
 performed under conscious sedation.

 
We can see an esophageal varix with a white point (ulcer). The probable bleeding point has been identified, with extensive fibrosis in the surrounding area because of previous banding sessions.

Video Endoscopic Sequence 2 of 10.

 We can see an esophageal varix with a white point (ulcer).
 The probable bleeding point has been identified, with
 extensive fibrosis in the surrounding area because of
 previous banding sessions.

 
More image and video clip of the varix and it ulceration

Video Endoscopic Sequence 3 of 10.

More image and video clip of the varix and it ulceration

 The mucosa and submucosa of the esophagus (containing
 the variceal channels) are ensnared, leading to
 strangulation, sloughing, and eventual fibrosis—ideally
 with obliteration of the varices.

 
StdCarlvarix4

Video Endoscopic Sequence 4 of 10.

 The banding treatment has been initiated, due to the fibrosis near of the varix, we have some experience that the band can be slid

 

Video Endoscopic Sequence 5 of 10.

 Jet of blood from an esophageal varix

 After several attempts to suck, bleeding is activated but we
 continued trying to suck until finally sufficient tissue of
 varix is sucked and two bands go off.
StdCarlvarix6

Video Endoscopic Sequence 6 of 10.

 

Important advances have been made in the management of variceal bleeding. Despite these advances, bleeding in the patient with cirrhosis remains one of the most demanding clinical challenges that a gastroenterologist may face

 
Hemostasis achieved in bleeding varix by the endoscopic application of rubber bands onto the bleeding site. Hemostasis achieved in bleeding varix by the endoscopic application of rubber bands onto the bleeding site two bands were deployed .

Video Endoscopic Sequence 7 of 10.

 Hemostasis achieved in bleeding varix by the endoscopic
 application of rubber bands onto the bleeding site two
 bands were deployed.

 
Esophageal varix which have been successfully banded.

Video Endoscopic Sequence 8 of 10.

Esophageal varix which have been successfully banded.

 

Video Endoscopic Sequence 9 of 10.

One band falls, observing the ulcer in the tip of the varix

 
Due to the considerable amount of fibrous tissue surrounding the vessel, in spite of successful banding of the blood vessel, sclerotherapy was administered in the three upper paravariceal cuadrants, to prevent the band from slipping.

Video Endoscopic Sequence 10 of 10.

 Due to the considerable amount of fibrous tissue
 surrounding the vessel, in spite of successful banding of the
 blood vessel, sclerotherapy was administered in the three
 upper paravariceal cuadrants, to prevent the band from
 slipping.