Variceal ligation with bands and clips.

While endoscopic sclerotherapy is effective for management of variceal bleeding, significant local and systemic side effects promoted the development of alternative endoscopic therapies. Endoscopic band ligation has emerged as a technique with equal or greater efficacy and fewer local and systemic complications. New multibanded ligation systems have enhanced the speed and efficiency of endoscopic variceal ligation therapy and eliminated the need for an esophageal overtube. Endoscopic hemostatic clipping is another means of achieving directed, mechanical endoscopic hemostasis that has a limited role in variceal bleeding.