58 year-old man with a history of alcoholism and physical findings suggestive of cirrhosis, presented with gastrointestinal bleeding in the form of passing port-wine colored stools. Nasogastric aspirate was not grossly bloody; nonetheless, endoscopy was performed on the basis of clinical suspicion. The esophagus, stomach and duodenum appeared normal. In the postbulbar duodenum there were serpiginous varices with a focus of intermittent bleeding.


Close-up of varix and bleeding site, here seen between bleeding episodes.


A single rubber band was applied to the site, with complete cessation of bleeding. The black rubber band is seen encircling the portion of the varix which contained the bleeding site, which is now entrapped within the band. This photograph was taken with the banding apparatus still attached to the endoscope; note the degree to which the attachment narrows the field of view.