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PubMed2002

Ligation of the native ureter in renal transplantation.

PURPOSE: Native ureteral ligation may be required in renal transplantation when ureteroureterostomy is performed. Native nephrectomy has been done to avoid the complication of hydronephrosis after native ureteral ligation. We reviewed the records of renal transplant recipients who underwent native ureteral ligation to determine the incidence of post-ligation symptoms and need for native nephrectomy. MATERIALS AND METHODS: We retrospectively reviewed 1,275 renal transplants performed from January 1986 through September 1999, including 278 cases (22%) of native ureteral ligation. The majority of patients had anuria or oligouria before transplantation, although 3 were not dialysis dependent. Followup was 1 to 140 months. Charts were reviewed for flank pain, infection and the need for native nephrectomy. RESULTS: Six of 278 patients (2.2%) required native nephrectomy 7 to 82 months after transplantation with flank pain as the indication in all. The cause of renal failure was polycystic disease in 3 of the 6 cases, unknown in 2 and diabetes in 1. The patient with diabetes had papillary necrosis and bleeding in the nephrectomized kidney. None of the 278 patients had infection and early post-ligation flank pain developed in only 1 (0.4%). CONCLUSIONS: The native ureter may be safely ligated during renal transplantation. Late nephrectomy may be required in a small percent of cases, most commonly in those of polycystic disease. The need for nephrectomy is most often related to the original renal disease.

Adult↗

PubMedDate not supplied

A prospective randomised study of local anaesthetic injection after multiple rubber band ligation of haemorrhoids.

One hundred and forty-two patients with second and third degree internal haemorrhoids were randomised to rubber band ligation only (n = 72) or rubber band ligation + local anaesthetic injection (n = 70). Pain was assessed by the patients at intervals of 6 hours and 1, 2, 3 and 4 days after banding. Other symptoms, complications, analgesic requirements and patient satisfaction were also recorded for 10 days following the treatment. There was a significant reduction in pain at 60 minutes and 6 hours after the procedure in the rubber band ligation plus local anaesthetic injection patients compared with the rubber band ligation only group (P < 0.05), but there was no reduction in pain when local anaesthetic was used compared with rubber band ligation only on days 1, 2, 3 and 4 days after ligation. On day 10 after banding, there was no difference between the two groups with respect to symptoms such as nausea, feeling of heaviness and/or tenesmus, fainting; complications, analgesic consumption or overall patient satisfaction. Bupivacaine injection after multiple rubber band ligation may be useful in reducing pain during the first 6 hours of the postbanding period.

Adult↗

PubMed1976

The technique of primary arterial ligation for cancer of the colon as suggested by venous and lymphatic outflow studies.

Because veins and lymphatics constitute the major pathways for metastatic spread of cancer of the colon, the dynamics of venous and lymphatic outflow from the intestine were studied in dogs with use of electromagnetic flowmeter for the veins and cannulation and gravimetric measurement for the lymph. Venour ligation produced sixfold increases in lymph flow. Venous outflow doubled when adjacent veins were occluded but dropped when marginal vessels were ligated. Simultaneous ligation of arteries and veins caused significant decreases in lymph outflow (to 26% of control), but if arterial collaterals remained intact, lymph flow rose more than twofold. Venous outflow doubled after simultaneous occulusion of adjacent arteries and veins, but dropped as marginal vessels were ligated. Arterial ligation alone was most satisfactory, resulting in significant rapid decreases in lymph flow (to 32% of control) and venous flow (to 5% of control. As suggested by these studies, primary arterial ligation, followed by marginal vessel ligation, is being used as a modification of the "no touch" technique for cancer of the colon.

Animals↗

PubMed2005

[Bilateral hypogastric artery ligation for control of pelvic hemorrhage, reduction of blood flow and preservation of reproductive potential. Experience with 117 cases].

MATERIAL AND METHOD: The topography of the hypogastric (internal iliac) artery, its pelvic collateral anastomoses, the procedure and physiological consequences of hypogastric artery ligation are described. Indications and clinical findings in 117 cases of bilateral hypogastric artery ligation for uncontrollable pelvic bleeding are presented. RESULTS: In all 37 obstetric cases, hemorrhage was effectively controlled. There was no need for reoperation, and in 13 cases even the uterus could be preserved, with 4 women having delivered mature infants up until now. The uterus was successfully preserved even in cases such as cervical pregnancy, placenta previa, placental abruption, uterine atony, and uterine rupture. Out of 80 gynecological cases, hypogastric ligation was performed to control intractable hemorrhage in 41 patients, while prophylactic reduction of pelvic blood flow was the indication of the procedure in 39 cases. Prophylactic ligation was performed in 34 women because profuse bleeding was expected. In the remaining 5 cases, the procedure was done for requests of patients who were members of Jehova's Witnesses. Out of cases with preserved uterus one woman delivered mature infant up until now. Apart from a slight lesion of the hypogastric vein, no complications have been observed in relation to these 117 cases of bilateral hypogastric artery ligation. CONCLUSION: It is emphasized that hypogastric artery ligation is indicated if (1) life-threatening pelvic hemorrhage cannot be controlled by conservative methods, (2) prophylactic reduction of pelvic blood flow is needed, (3) during the management of uncontrollable massive hemorrhage, preservation of reproductive functions and/or female identity is desirable. Ligation of the hypogastric artery has proven to be a safe and usually effective method. This easy-to-acquire technique should be practiced by most gynecologists and should be an integral part of obstetric and gynecological training.

Adult↗

PubMed2006

[Changes of hemodynamics during establishment of animal model of acute myocardial infarction induced by ligation of left coronary artery in goat].

OBJECTIVE: To study the changes in hemodynamics in experimental acute myocardial infarction induced by ligation of the left coronary artery in goat. METHODS: Animal model of acute myocardial infarction was reproduced in 20 goats by ligation of the left coronary artery through xyphoid process. ST segment of electrocardiogram (ECG), mean artery blood pressure (MAP), central venous pressure (CVP), and heart rate (HR) were observed before, immediately, 30 minutes, 1 hour and 2 hours after ligation of the left coronary artery. RESULTS: ECG of all goats was normal before operation. Immediately and 30 minutes after ligation, elevation of ST-segment was seen in 8 and 10 goats respectively, and in 18 goats elevation of ST-segment was observed 2 hours after ligation. Four weeks after the operation, pathological Q wave was shown in the chest leads of ECG in 18 goats. There was no significant difference in MAP, CVP and HR between before and after ligation. Frequent ventricular premature beats were found in 6 goats, but they were stopped after intravenous infusion of lidocaine. CONCLUSION: Small area of experimental acute myocardial infarction in goats shows slight effect on hemodynamics, though the production of myocardial infarction is reliable, and the life of the goats could be maintained for a long time after the ligation of the left coronary artery. The experiment provides a valuable animal model for the study of coronary heart disease.

Animals↗

PubMed2006

[Effect of mesenteric lymph duct ligation on nitric oxide content and its expression in lung in rats with hemorrhagic shock].

OBJECTIVE: To observe the effect of mesenteric lymph duct ligation on nitric oxide (NO) and its expression in lung in rats with serious hemorrhagic shock at different periods, and explore the role of intestinal lymphatic pathway in acute lung injury (ALI). METHODS: Seventy-eight male Wistar rats were randomly divided into the sham operation group (n=6), shock group (n=42), and ligation group (n=30). The model of serious hemorrhagic shock was reproduced in shock group and ligation group. Mesenteric lymph was diverted by ligating mesenteric lymph duct in ligation group after resuscitation. All rats were executed and their lungs were harvested. NO and nitric oxide synthase (NOS) were determined in lung homogenate 90 minutes after shock, and 0, 1, 3, 6, 12 and 24 hours after resuscitation. The expression of inducible nitric oxide synthase (iNOS) mRNA was detected by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: The content of NO, activity of NOS and expression of iNOS mRNA in lung tissue in shock group were increased 3 hours after transfusion and resuscitation, and they became higher 6-12 hours after resuscitation. The values were significantly higher than those in sham operation group, 90 minutes after shock and 0 hour after transfusion and resuscitation (P<0.05 or P<0.01). The values were only increased 3 hours and 6 hours after transfusion and resuscitation, and all the values on 6, 12 and 24 hours after resuscitation were significantly lower in the ligation group compared with those in shock group at the same time points (P<0.01 or P<0.05). CONCLUSION: The results demonstrate that the ligation of mesenteric lymph duct could reduce the NO and expression of iNOS mRNA in the lung tissue, thus ameliorate ALI in rats with serious hemorrhagic shock. Mesenteric lymph might play an important role in the pathogenesis of ALI.

Animals↗

PubMed1987

[Histochemical study of retrograde degeneration in ligated peripheral nerves].

The enzyme specificity of the Karnovsky staining was examined. Tetraisopropylpyrophosphoramide made the staining difference between anterior and posterior roots clearer. Rat sciatic nerve, gluteal muscle branch and sural nerve were ligated and retrograde changes were examined histologically and histochemically. In ligated sciatic nerve, axonal degeneration similar to Wallerian degeneration occurred within 5 mm proximal to ligation while acetylcholinesterase activity decreased in more proximal portions. Sections of ligated gluteal muscle branch showed marked increase of small myelinated fibers 6 weeks after ligation and the mean cross sectional area of myelinated fibers decreased due to the new small fibers. The mean cross sectional area of myelinated axons also decreased in ligated sural nerve but myelinated fibers did not so remarkably increase in number as ligated gluteal muscle branches. Histochemical funicular orientation could be reliable if performed soon after nerve injury before retrograde changes spread in the proximal stump.

Acetylcholinesterase↗

PubMed1985

The effect of acute and chronic femoral artery ligation on the blood flow through the gastrocnemius muscle of the rat examined using laser Doppler flowmetry and xenon-133 clearance.

In this investigation the resting gastrocnemius muscle blood flow of the anaesthetized rat was evaluated using a recently developed laser Doppler flowmeter and the xenon-133 clearance technique. The perfusion of the microvasculature of the muscle was measured in normal control rats and in animals in which the supplying femoral artery had been acutely (1 h-1 week) or chronically (8-12 weeks) ligated. The laser Doppler flowmeter allowed continuous measurements of the muscle perfusion. Such measurements revealed a rhythmic fluctuation in the perfusion of the gastrocnemius muscle. The xenon-133 clearance technique did not allow continuous recording of muscle blood flow and rhythmical flow changes could not be observed. Acute ligation of the femoral artery reduced the mean muscle perfusion by 41% and 52% when assessed by laser Doppler flowmetry and xenon-133 clearance respectively. In comparison to animals without femoral artery ligation the hyperaemic response, following release of a tourniquet around the thigh or of an abdominal aortic occlusion, was markedly attenuated. Chronic ligation of the femoral artery reduced the mean muscle perfusion by 33% and 32% when assessed by laser Doppler flowmetry and xenon-133 clearance respectively. In these animals the hyperaemia, following tourniquet-induced muscle ischaemia, was reduced, compared to normal animals, but was more pronounced than observed in acutely ligated animals. In the chronically ligated animals abdominal aortic occlusion did not produce sustained muscle ischaemia and consequently no hyperaemic response was observed upon release of the aortic occlusion. We conclude that, as judged by the comparability of the results obtained using xenon-133 clearance, the laser Doppler flowmeter is a useful and sensitive new tool for the examination of the perfusion of tissue blood flow. The results suggest that chronic ligation of the rat femoral artery induces circulatory changes which mimic those seen in claudicants.

Animals↗

PubMed1986

Biochemical background of the development of gastric mucosal damage in pylorus-ligated plus aspirin-treated rats.

Gastric mucosal damage was produced in rats after pyloric ligation by intragastric administration of 200 mg/kg aspirin diluted in 2 ml 150 mmol/l HCl. The animals in the control group received 2 ml saline solution, or submitted to pyloric ligation only. The animals were killed 4 h after the pyloric ligation, when the number and severity of gastric lesions (ulcers), and the gastric fundic mucosal level of adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), cyclic adenosine monophosphate (cAMP) and lactate, were noted and measured. The adenylate pool (ATP + ADP + AMP) and the energy charge (ATP + 0.5ADP). (ATP + ADP + AMP)-1 were calculated. It was found that: the gastric H+ output decreased significantly in the pylorus-ligated plus aspirin-treated animals; the number and severity of gastric lesions increased significantly in the pylorus-ligated aspirin-treated animals; the extent of ATP transformation into the ADP decreased significantly in the pylorus-ligated aspirin-treated animals; the extent of ATP transformation into the cAMP decreased significantly during the aspirin treatment; the values of adenylate pool and of "energy charge" remained unchanged in the different groups of animals. It is concluded that: the decreased H+ output in the pylorus-ligated plus aspirin-treated group can be obtained by the decreased extent of ATP transformation into the ADP by membrane ATPase, and the biochemical changes in the gastric mucosa indicate a decreased energy turnover.

Absorption↗

PubMed1988

Changes in choroidal blood flow following ligation of common carotid artery.

The effects of carotid artery ligation on choroidal blood flow were studied in 30 rabbits using a hydrogen clearance method. The choroidal blood flow (ChBF) decreased significantly to about 75% for 60 minutes after the ipsilateral ligation of the common carotid artery. In 11 of the rabbits ChBF was measured both one and six weeks after ligation. ChBF recovered to 88% of the resting level one week after the ligation, and returned to the resting values six weeks after the ligation. The left carotid artery was ligated six weeks after ligation of the right carotid artery, and there was not any significant change in the ChBF of the right eye. It seemed that the recovery of the ChBF of the right eye was not through the contralateral carotid artery.

Animals↗

PubMedDate not supplied

Induction of rat liver alkaline phosphatase by bile duct ligation.

Bile duct ligation causes a five- to sevenfold increase in the activity of rat liver alkaline phosphatase within 12 hours after ligation and a similar rise in the activity of alkaline phosphatase in serum. The increased serum activity is due entirely to the appearance of a new isoenzyme that has the properties of rat liver alkaline phosphatase. The increase in both serum and liver alkaline phosphatase is prevented by the prior administration of cycloheximide in a dose that inhibits protein synthesis by 70%. Rat liver alkaline phosphatase was then purified to homogeneity. Antibody was raised to purified rat liver alkaline phosphatase in rabbits. The antibody was coupled to sepharose 4B and affinity columns made. (3)-H-leucine was then injected into the portal veins of sham operated rats and rats with bile duct ligation four hours after ligation. One hour after injection and five hours after ligation, animals were sacrificed. Liver alkaline phosphatase was purified by means of affinity chromatography and double immunoprecipitation with rabbit antibody to rat liver alkaline phosphatase and goat anti-rabbit gamma globulin. Bile duct ligation increased the incorporation of (3)-H-leucine into liver alkaline phosphatase more than threefold compared with sham operated rats, 164 CPM/mg protein vs. 49 CPM/mg protein (p < .001). The data indicate that the increased activity of rat liver alkaline phosphatase after bile duct ligation is due to enzyme induction rather than to activation of a pre-existing, relatively inactive enzyme.

Alkaline Phosphatase↗

PubMed1984

Importance of renal prostaglandins in control of renal function after chronic ligation of the common bile duct in dogs.

To explore the possible vasoregulatory role of renal prostaglandins during liver disease, excretory rates of PGE2, PGF2 alpha, and a metabolite of PGI2, 6k-PGF1 alpha, were determined before and after chronic ligation of the common bile duct in 23 dogs. Bile duct ligation for 50 +/- 3.7 days (mean +/- SEM) significantly increased serum bilirubin and alkaline phosphatase. PGE2, PGF2 alpha, and 6k-PGF1 alpha excretion rates were significantly (p less than 0.01) increased following chronic bile duct ligation, by approximately 100%, 80%, and 500%, respectively, with similar increments in both ascitic and nonascitic animals. In 10 sham-ligated animals, PGE2, PGF2 alpha, and 6k-PGF1 alpha excretion rates were unchanged. In 6 dogs sequential measurements of urine prostaglandins indicated that PGE2 and 6k-PGF1 alpha excretion were significantly increased at 2, 4, and 6 weeks after ligation, whereas the increase in PGF2 alpha excretion was not significant until 6 weeks. Indomethacin (2 mg/kg) reduced prostaglandin excretion by 65% to 90% and significantly increased arterial pressure, decreased glomerular filtration rate and renal blood flow, and increased renal vascular resistance from 0.53 +/- 0.09 to 0.90 +/- 0.13 mm Hg/ml/min. Fractional renal blood flow, assessed by microspheres, was disproportionately reduced in the inner cortex after prostaglandin inhibition in the chronic bile duct ligation group. Indomethacin did not significantly alter renal function in sham animals, despite comparable reductions in prostaglandin excretion. These data demonstrate that, in dogs with experimental liver disease produced by chronic bile duct ligation, renal prostaglandin synthesis is increased, and the enhanced synthesis of vasodilatory prostaglandins serves to maintain renal blood flow and glomerular filtration rate.

6-Ketoprostaglandin F1 alpha↗

PubMed1982

Blunted pressor response to volume load in conscious dogs with chronic bile duct ligation.

Dogs with chronic bile duct ligation have a decreased natriuretic response ot an acute extracellular volume expansion. The present investigation was undertaken in order to study the role of hemodynamic factors in causing the decreased natriuretic response to extracellular volume expansion in chronic bile duct ligated dogs. Five trained, conscious dogs were studied before, and 6 weeks after chronic bile duct ligation, each dog serving as its own control. Under basal conditions systemic hemodynamics were normal following chronic bile duct ligation. However, chronic bile duct ligation was associated with a blunted pressor response to extracellular volume expansion. Thus, at peak extracellular volume expansion, chronic bile duct ligated dogs had smaller increase in mean arterial pressure (P less than 0.05), an exaggerated decrease in systemic vascular resistance (P less than 0.05), and similar cardiac output as compared with normal dogs. This blunted pressor response to extracellular volume expansion may contribute to the decreased natriuresis seen following this maneuver in chronic bile duct ligated dogs.

Animals↗

PubMed1995

Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: a prospective randomized trial.

To determine the efficacy of endoscopic variceal sclerotherapy (EVS) and ligation (EVL) in the management of esophageal variceal bleeding, 134 cirrhotic patients were randomized to receive either treatment. The clinical and endoscopic characteristics were similar in both groups. Active bleeding was controlled with ligation (20 of 20) as efficiently as with sclerotherapy (14 of 16). Elective sclerotherapy consumed less time than ligation (7.9 +/- 1.8 minutes vs. 11.5 +/- 2.7 minutes, P < .001), but there was no difference between emergent sclerotherapy (14.5 +/- 5.8 minutes) and ligation (14.9 +/- 4.1 minutes). Ligation reduced one grade of variceal size more quickly than sclerotherapy (1.1 +/- 0.4 vs. 2.0 +/- 1.7 session, P < .001). The rebleeding rate was lower with ligation (13 of 67 vs. 28 of 67, P < .01). Esophageal ulcer was the most common source of rebleeding. Recurrence of varices appears more probable with ligation (P = .079). The complication rate was higher with sclerotherapy (15 of 67 vs. 3 of 67, P < .01), with esophageal stricture being the most common cause. Survival rate was the same in both groups even after stratifying patients into good and poor hepatic reserve groups. Hepatic failure was the major cause of death, followed by exsanguination. In summary, EVL was superior to EVS regarding rebleeding and complications but not in other aspects such as time consumption in elective treatment and recurrence of varices. Substantial results for long-term follow-up are required before conclusion of the treatment of choice.

Esophageal and Gastric Varices↗

PubMed1995

Venous injury: to repair or ligate, the dilemma revisited.

Controversy continues over management of major venous injuries. The records of 322 patients with venous injury were reviewed. Isolated venous injury was present in 83 patients; 54 (65%) underwent ligation of the injured vein. Combined arterial and venous injuries were present in 239 patients; 170 (71%) patients had ligation. Injured were the inferior vena cava, iliac, femoral, popliteal, distal leg, and arm veins; all were confirmed at surgery. Arterial injuries were repaired with standard techniques; venous injuries were ligated or repaired by end-to-end or lateral phleborrhaphy. Adjunctive fasciotomy was used as clinically indicated. The patients were followed an average of 32 months. No patient with isolated venous injury developed permanent sequelae, although 29 (35%) had transient extremity edema. Transient edema developed in 86 (36%) patients with combined injury, and permanent edema occurred in 4 (2%). Edema developed regardless of vein injury ligation or repair. No extremity was lost after venous injury ligation. While repair of all venous vascular injuries is still the surgical ideal, in civilian practice permanent sequelae of venous injury ligation are rare and in patients with hemodynamic instability from blood loss, extensive local injury, associated organ injury, anesthesia requirements, or other concerns venous ligation is acceptable.

Adolescent↗

PubMedDate not supplied

A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices.

A comparison of the incidence of transient bacteremia and infectious sequelae in patients undergoing sclerotherapy and those undergoing variceal ligation has not yet been reported. Fifty patients admitted with acute esophageal variceal bleeding were treated with sclerotherapy between July 1990 and July 1991. Fifty-five patients were treated with banding ligation between July 1991 and July 1992. Blood cultures were taken before and 5 minutes, 30 minutes, and 24 hours after treatment to compare the incidence of transient bacteremia in each group. The incidence of infectious sequelae during hospitalization was also compared. Transient bacteremia occurred in 17.2% of the sclerotherapy group and in 3.3% of the ligation group (p < 0.03). Infectious sequelae occurred in 18% of the sclerotherapy group and 1.8% of the ligation group (p < 0.01). Apart from bacteremia, the most frequently encountered infectious sequela was spontaneous bacterial peritonitis. Both transient bacteremia and infectious sequelae are more likely to develop when liver disease is severe. Two patients in the sclerotherapy group but none in the ligation group died of infectious sequelae. The incidence of transient bacteremia and infectious complications after sclerotherapy for acute variceal bleeding is about 5 to 10 times greater than that after variceal ligation. Inasmuch as it is equally effective and entails fewer infectious complications, variceal ligation is preferable to sclerotherapy for patients with acute variceal bleeding. Further randomized trials are needed.

Acute Disease↗

PubMed1994

Haemodynamic changes in the rat femur and tibia following femoral vein ligation.

Interference with venous outflow from a limb to stimulate fracture repair and bone growth has a long history, and its beneficial effects have been confirmed by many experimental and clinical studies. With the development of fracture fixation systems, the therapeutic use of circulatory intervention became redundant. Recently, a venous tourniquet effect has been cited to explain the enhancement of bone healing observed after fracture fixation with the Aircast system. As bone appears to be altered by venous stasis, it is important to characterise the vascular perturbations leading to these changes. Previous studies have often given conflicting results. This study investigated the short and long term haemodynamic effects of femoral vein ligation. Changes in blood flow rate and blood volume in the distal femur and proximal tibia of the rat were examined at 6 h and 1, 3 and 7 d following unilateral femoral vein ligation, and at 8 and 16 wk. Blood flows and volumes were generally reduced in the ligated limb 6 h after femoral vein ligation. This initial depression was followed by a relative increase (comparing the ligated limb with the contralateral unoperated bone) in blood volume during the 1st week. A significant relative reduction in epiphyseal vascular space was observed after 16 wk. A sustained reduction of arterial input to whole femora and tibiae was present in the ligated limb throughout the investigation although, for the cancellous knee joint epiphysis of the tibia, a localised relative increase in flow was apparent during the 1st week, again comparing the ligated limb with the nonligated contralateral bone.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1994

Sequelae after esophageal variceal ligation and sclerotherapy: a prospective randomized study.

OBJECTIVES: Esophageal variceal ligation is a new approach to the treatment of esophageal varices that does not result in transmural tissue injury and inflammation, and therefore might produce fewer sequelae and symptoms than sclerotherapy. We conducted a prospective, randomized comparison of sclerotherapy with ligation to study the relative short-term risks of these two procedures with respect to bacteremia, pulmonary and coagulation function, esophageal motility, and gastroesophageal reflux. METHODS: Patients with previously documented high grade esophageal varices were randomized to receive sclerotherapy or ligation. Blood was drawn for culture and coagulation profiles, and patients underwent pulmonary function tests, esophageal manometry, and intraesophageal pH monitoring before and after treatment. RESULTS: Six patients with Childs class B cirrhosis and one patient with pre-sinusoidal portal hypertension underwent 20 courses of therapy. Neither sclerotherapy nor ligation produced significant clinical changes in pulmonary or coagulation parameters, or bacteremia requiring treatment. The majority of ligation treatments were without worsening of motility or reflux scores, and none were associated with symptoms. Sclerotherapy was followed by significantly greater esophageal dysmotility and worsening reflux patterns. CONCLUSIONS: Patient acceptance of ligation was much greater than that for sclerotherapy. Our data define the advantages of ligation over sclerotherapy.

Bacteremia↗