Ligation of oesophageal varices
- Lubricate the scope and exterior part of the band barrel ensuring that no lubricant has entered the barrel.
- Roll back the big wheel 180˚ to permit that the tracking wires is not fully straightened so that no band is shot while inserting the endoscope into the patient.
- When in place, tension again the tracking wire using the small wheel to prepare for the shooting (be sure that the alignment arrows on the handle are facing each other).
- Locate the selected varix and aspirate it into the band barrel.
- To fire the band, slowly rotate 180º forward the big wheel. More than one ligation band for each varix might be needed to control acute bleeding.
- Release the suction button of the scope, insufflate air and then withdraw the scope slightly to release the ligated varice.
- Repeat the procedure until the last varix is banded.
- The luer-lock connection is available to ensure irrigation of the scope biopsy channel if required. After removing the blue cap, attach the luer-lock connector to a syringe filled with sterile water and irrigate.
- After irrigation put back the blue cap to ensure good suction.
- In case additional bands are needed, remove the scope and attach a new Multiband Ligator starting back from the mounting steps.
Removing the Multiband Ligator
- Once the ligation procedure is completed, remove the scope from the patient.
- Dismantle the the Multiband Ligator as follows:
- If any unused bands are still on the barrel shoot all remaining bands.
- Remove the Multiband Ligator handle from the biopsy channel by pulling it, the remaining tracking wire attached with the handle should be removed also.
- Remove the band barrel from the scope tip.
- Dispose all parts per institutional guidelines for biohazardous medical waste.
- If all bands have been used, you can remove the Multiband Ligator from the biopsy channel and continue using the scope and its biopsy channel while still inside the patient.