Abstract
Background
Post-banding ulcer bleeding is a rare complication of endoscopic band ligation of
esophageal varices with high morbidity and mortality. There exist no management guidelines
for this complication.
Aims
To determine the incidence, outcome and risk factors of post-banding ulcer bleeding.
Methods
Data for cirrhotic patients with acute variceal bleeding during a six-year period
were prospectively collected, and all band ligation sessions performed were retrospectively
analyzed. Demographic, analytic and endoscopic data were recorded, as well as complications,
outcome and management of each episode of post-banding ulcer bleeding.
Results
The study includes 521 band ligation sessions performed on 175 patients. There were
24 cases of post-banding ulcer bleeding in 21 patients (incidence 4.6%). Independent
risk factors for post-banding ulcer bleeding were MELD score, hepatocellular carcinoma
and total beta-blocker dose. Mortality during the bleeding episode was 23.8%. Active
bleeding or adherent clots at the time of endoscopy was associated with treatment
failure or death.
Conclusions
Post-banding ulcer bleeding is an uncommon but severe complication of esophageal banding.
Patients with hepatocellular carcinoma, poor liver function and a low beta-blocker
dose have higher risk of post-banding ulcer bleeding. An aggressive treatment should
be considered in case of active bleeding at endoscopy.
Keywords
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References
De Franchis R. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension.
- J. practice guidance: portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases.Hepatology. 2016; 65: 310-335
- Chronology of histological changes after band ligation of esophageal varices in humans.Endoscopy. 2001; 33: 443-447
- Predictive factors of bleeding related to post-banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case-control study.Aliment Pharmacol Ther. 2010; 32: 225-232
- A prospective study of conventional and expanded coagulation indices in predicting ulcer bleeding after variceal band ligation.Clin Gastroenterol Hepatol. 2009; 7: 988-993
- Risk factors for band-induced ulcer bleeding after prophylactic and therapeutic endoscopic variceal band ligation.Eur J Gastroenterol Hepatol. 2015; 27: 928-932
- Interventions and outcomes of treatment of postbanding ulcer hemorrhage after endoscopic band ligation: a single-center case series.Gastrointest Endosc. 2013; 77: 136-140
- Rebleeding prophylaxis improves outcomes in patients with hepatocellular carcinoma: a multicenter case-control study.Hepatology. 2013; 58: 2079-2088
- Differences in bleeding behavior after endoscopic band ligation: a retrospective análysis.BMC Gastroenterol. 2010; 10
- The effects of the number of rubber bands placed at each endoscopic session upon variceal outcomes: a prospective, randomized study.Am J Gastroenterol. 2007; 102: 1372-1376
- Prophylactic administration of blood products does not prevent bleeding after endoscopic band ligation of varices.J Hepatol. 2015; 62: S389
- Pantoprazole reduces the size of postbanding ulcers after variceal band ligation: a randomized, controlled trial.Hepatology. 2005; 41: 588-594
- Early use of TIPS in patients with cirrhosis and variceal bleeding.N Engl J Med. 2010; 362: 2370-2379
Article info
Publication history
Published online: August 06, 2019
Accepted:
June 23,
2019
Received:
August 17,
2018
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
