Time Interval for Endoscopic Variceal Ligation

Patients with liver disease frequently present to the hospital with bleeding from dilated
veins in their foodpipe (called esophageal varices). The current standard of care is to
perform endoscopic variceal ligation (placing rubber bands around the varices through an
endoscope)in patients presenting with bleeding varices. Patients generally receive ligation
at the time they come in with bleeding and then return at regular intervals to have repeat
ligation in order to eradicate the varices. However there have been no studies to determine
the appropriate intervals for esophageal variceal ligation until eradication. We will
conduct a randomized comparison of 1-week vs. 2-week intervals for esophageal ligation in
patients that have presented with bleeding varices. Our hypothesis is that one-week ligation
will achieve more rapid eradication than the two-week interval with a greater proportion of
patients achieving variceal eradication at 4 weeks after the index bleeding episode.