Leak after Whipple Resection: Preventable?

133 While the safety of endoscopic banding liga-tion is largely undisputed, there is one major risk of this technique: esophageal perforation during insertion of the overtube. Perforation of the esophagus often occurs as a result of inability to relax the pharyngeal muscle by the patient and forceful insertion of the tube by the endoscopist. The development of multiple banding ligators (Speedband TM and Six-shooterTM) in recent years has obviated the use of an overtube and is truly major advancement. Intubation is not more difficult with the endoscope loaded with these multiple band ligators and the procedure time is significantly shortened [7, 8]. Recently, a detachable mini-loop ligator has been developed and its use is currently under investigation. I believe that endoscopic banding ligation will continue to gain popularity. Future development in this treatment modality should be directed to the prevention of recurrent varices formation, the improvement of multiple banding devices and the study of prophylactic banding ligation for selected cases with high risk of variceal bleeding. Re[erences [1] Laine, L. and Cook, D. (1995). Endoscopic ligation compared with sclerotherapy for treatment of esopha-geal varices. A meta-analysis. D'lmperio, N. A. (1997). A prospective randomized trial of sclerotherapy versus ligation in the elective treatment of bleeding esophageal varices. venous collaterals on efficacy of endoscopic sclerother-apy for esophageal varices. Hepatology, 19, 602-8. Large para-esophageal varices on endosonography predict recurrence of esophageal varices and rebleed-comparision of ligation versus ligation plus sclerother-apy in patients with bleeding esophageal varices. The Saeed Six-shoorter: a prospective study of a new endoscopic multiple rubber band ligator for the treatment of varices.