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Results
You will usually know right away how many bands were placed and how the varices looked. How well the treatment worked is judged over the following weeks and months, with repeat scopes until the varices are gone or small, and then regular check scopes. Your liver team will explain how often you need them.
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
In advanced liver disease (cirrhosis), blood has trouble flowing through the scarred liver, so the pressure in the veins that lead to it rises (portal hypertension). Blood then finds other routes, and some veins in the lining of the lower food pipe (oesophagus) and sometimes the stomach become swollen and thin-walled. These are called varices (oesophageal varices when in the food pipe). They can burst and bleed heavily, which is an emergency. In variceal banding (also called band ligation), the doctor passes an endoscope (a flexible camera tube) through the mouth, sucks a varix into a small cap on the tip, and releases a tight rubber band around its base. The varix is cut off from its blood supply, shrinks, and drops off with the band within days to a couple of weeks, leaving a small shallow ulcer that heals. Several sessions are usually needed to get rid of the varices.
Why is it done?
It is done to stop bleeding from varices during an emergency, to prevent bleeding in people whose varices are large or have signs of high risk, and to prevent a second bleed after a first one. Banding is one of the main ways to protect people with portal hypertension from a life-threatening bleed. It is often combined with medicines that lower the pressure in the veins, and treatment of the underlying liver disease remains essential.
Who needs it?
- People with cirrhosis who are bleeding from oesophageal varices (urgent)
- People with cirrhosis whose screening endoscopy shows medium or large varices, or varices with high-risk signs, when their doctor advises banding
- People who have bled from varices before, to prevent another bleed (repeat sessions until the varices are gone, then follow-up checks)
- People who cannot take, or do not tolerate, pressure-lowering tablets
Before the procedure
- If this is planned, you will usually need to stop eating and drinking for several hours before the test, as for a gastroscopy. Your centre will give the exact fasting times and tell you how to take your medicines.
- Tell the team about all your medicines, especially blood thinners and anti-platelet medicines (warfarin, apixaban, rivaroxaban, clopidogrel, aspirin) and anti-inflammatory painkillers. Never stop any medicine unless told to. Do not stop your pressure-lowering tablets (such as propranolol or carvedilol) unless your doctor says so.
- Tell the team about allergies, heart or lung conditions, kidney problems, any history of confusion from liver disease, and earlier problems with sedation.
- Light sedation is usually given, so arrange for an adult to take you home and stay with you.
- If you are bleeding urgently you will be treated in hospital: you will get fluids, medicines, sometimes a blood transfusion and antibiotics, and the scope is usually done as soon as it is safe, often within 12 hours.
- If you are fasting in Ramadan, speak to your liver team beforehand; planned banding sessions are usually scheduled around fasting, and if you are bleeding the procedure cannot wait.
During the procedure
You lie on your left side. A mouth guard protects your teeth and the scope. Your throat may be numbed with a spray and you are usually given sedation through a vein, so you are relaxed or asleep. The doctor looks at the food pipe and stomach, then places the cap-fitted scope against a varix, applies suction and fires a band. This is repeated on several varices, working upwards from the stomach junction, usually with a few bands each session. You may feel pressure or a brief tightness or chest discomfort when the suction is applied. The procedure usually takes about 15 to 30 minutes.
After the procedure
You rest until the sedation wears off. A sore throat, mild chest discomfort or pain when swallowing is common for a few days. You will usually be told to eat soft or liquid food at first (such as soups, yoghurt, mashed foods), avoid very hot, hard or sharp foods, and drink plenty of fluids as your doctor allows. Do not drive, sign legal papers or make important decisions for the rest of the day. The bands fall off with the dead tissue within about one to two weeks; you may not notice this. Ulcers left by the bands can bleed. Your doctor will usually plan repeat sessions every few weeks until the varices are gone, followed by check scopes. Keep taking the medicines your liver team prescribes, avoid alcohol completely, and avoid anti-inflammatory painkillers unless your doctor says they are safe.
Risks
- Sore throat, chest discomfort and pain when swallowing for a few days (common)
- Bleeding from the ulcers left after the bands fall off, usually 1 to 2 weeks after the procedure. It can be serious in people with advanced liver disease.
- Narrowing of the food pipe after repeated sessions, which can make swallowing harder (uncommon)
- Rarely, a tear (perforation) of the food pipe, or breathing in stomach contents into the lungs (aspiration) leading to pneumonia
- Infection, so antibiotics are sometimes given, especially in people who are bleeding
- Reactions to sedation, which may be more important in liver disease; they can trigger confusion (hepatic encephalopathy) in some people
- Banding lowers the risk of bleeding but does not remove it entirely, and new varices can form, so follow-up is important.
- Go to the emergency department at once if you vomit blood or material like coffee grounds, pass black or bloody stools, feel dizzy or faint, or have severe chest or belly pain, fever, or new confusion or drowsiness.
When you get results
Alternatives if you decline
Pressure-lowering tablets called non-selective beta-blockers (such as propranolol or carvedilol) can reduce the risk of a first bleed and are an alternative or an addition to banding for many people. Other options include injecting glue for stomach varices, a stent or balloon to control bleeding temporarily, and a procedure that creates a new channel in the liver to lower pressure (TIPS), usually in selected or severe cases. Each has benefits and risks, and your liver specialist will recommend what fits you best. Declining treatment leaves a real risk of a major bleed.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- How large are my varices, and how likely am I to bleed without treatment?
- Do I need banding, tablets, or both?
- How many sessions will I need, and how often are check scopes?
- What should I eat and avoid in the days after banding?
- Which symptoms mean I should go to the emergency department?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide