Quality statement 7: Band ligation for oesophageal variceal bleeding

Quality statement

People with acute upper gastrointestinal bleeding from oesophageal varices are given band ligation.

Rationale

The use of bands for oesophageal bleeding will stop the bleeding and has significant benefits over the alternative of injection sclerotherapy. The benefits include: improved mortality and a reduction in re-bleeding, numbers of additional procedures needed to control bleeding, total units of blood transfused and number of sessions of treatment needed to eradicate varices.

Quality measures

Structure

Evidence of local arrangements to ensure that people with acute upper gastrointestinal bleeding from oesophageal varices are given band ligation.

Data source: Local data collection.

Process

Proportion of people with acute upper gastrointestinal bleeding from oesophageal varices who receive band ligation.

Numerator – the number of people in the denominator who receive band ligation.

Denominator – the number of people with acute upper gastrointestinal bleeding from oesophageal varices.

Data source: Local data collection. Contained in NICE audit support for Acute upper gastrointestinal bleeding: variceal (NICE clinical guideline 141). The British Society of Gastroenterology's UK comparative audit of upper gastrointestinal bleeding and the use of blood (2007) shows the number of endoscopic therapeutic procedures, which includes banding.

Outcome

Rates of uncontrolled bleeding in people with upper gastrointestinal bleeding from oesophageal varices.

Data source: Local data collection.

What the quality statement means for service providers, healthcare practitioners, and commissioners

Service providers ensure that systems are in place for people with acute upper gastrointestinal bleeding from oesophageal varices to be given band ligation.

Healthcare practitioners perform band ligation in people with acute upper gastrointestinal bleeding from oesophageal varices.

Commissioners ensure that they commission services that give band ligation to people with acute upper gastrointestinal bleeding from oesophageal varices.

What the quality statement means for patients, service users and carers

People with acute upper gastrointestinal bleeding caused by enlarged veins in the oesophagus (gullet) are given band ligation, a type of elastic band that helps to stop the bleeding.

Source guidance

Acute upper gastrointestinal bleeding: management (NICE clinical guideline 141), recommendation 1.5.3.