Reloading of the variceal multiple-band ligator using haemorrhoidal banding apparatus.

Madam, Variceal ligation is the endoscopic procedure of choice to prevent recurrent variceal haemorrhage and eradicate varices 1,2 . Usually it takes 3-4 sessions for the purpose. Multiple band ligators are now available for rapid ligation 3,4 . These ligators do not require overtube or reloading of bands during the procedure and many bands may be deployed by just rotation of the pulley or handle attached to the endoscope’s accessory channel. These devices are intended for single use only and are too expensive and out of reach of cirrhotic patients coming from low socioeconomic classes. We have been reusing the multiple band ligator after reloading the barrel. We use the banding apparatus of haemorrhoids and haemorrhoidal bands for this process. Procedure: Disinfect the apparatus in glutaraldehyde solution. The plaited string or trigger cord of the multiple band ligator becomes separated into two threads near the barrel. Each thread has six beads at regular intervals starting from the tip of the thread. Pass these threads through the barrel of the multiple bands ligator from its scope-end side and deliver them from the transparent rim side. Now load the banding apparatus of haemorrhoids. Fit the metal cone at the end of the cylinder of the haemorrhoidal banding apparatus and roll the rubber band (ring) from the cone to the cylinder (Figure 1).