Endoscopic variceal ligation-induced ulcer bleeding

Abstract

This study was aimed to determine the risk factors of endoscopic variceal ligation-(EVL) induced ulcer bleeding.The prevalence of EVL-induced ulcer bleeding is reported to be 3.6%. However, there are only limited reports of this serious complication, and the risk factors and the treatment methods are not well established.A total of 430 patients who had undergone EVL in Chonnam National University Hospital from January 2014 to October 2016 were studied. EVL was performed for prophylaxis or acute hemorrhage. The patients were classified into 2 groups: a bleeding group (n = 33) and a non-bleeding group (n = 397). The patients who had endoscopically confirmed EVL-induced ulcer bleeding were included in the bleeding group.EVL-induced ulcer bleeding occurred in 7.7% (n = 33) of the patients. In a multivariate analysis, model for end-stage liver disease (MELD) score >10 (odds ratio [OR]: 3.42, 95% confidence interval [CI]: 1.10–10.64), concomitant GV F3 (OR: 14.1, 95% CI: 2.84–71.43), and detachment of o-ring bands on follow-up endoscopy (OR: 8.06, 95% CI: 2.55–25.64) were independent predictive factors of EVL-induced ulcer bleeding. Various endoscopic modalities were attempted for hemostasis (EVL in 8 cases [24.2%], endoscopic variceal obturation [EVO] with cyanoacrylate in 6 cases [18.2%], argon plasma coagulation [APC] in 1 case (3%), Sengstaken–Blakemore (SB) tube in 3 cases [9.1%]), and proton pump inhibitor therapy only in 15 cases (45.5%).MELD score >10, concomitant GV F3, and detachment of o-ring bands on follow-up endoscopy are risk factors for EVL-induced ulcer bleeding.

Esophageal Ulcers in Primary Biliary Cholangitis: A Rare Cause of Hematemesis in the Setting of Portal Hypertension and Esophageal Varices

“…If the necrotic tissue is sloughed off, an ulcer will appear but heal within a few weeks. If the band falls off before the surrounding varices are thrombosed, the blood vessels will be exposed in this new ulcer and subsequently cause bleeding, known as post-banding ulcer hemorrhage (PBUH) which occurs up to 15% of EBL cases [ 3 , 4 ]. This will manifest as hematemesis and increase mortality, length of stay, and readmission rates.…”

Case Control Study of Post-endoscopic Variceal Ligation Bleeding Ulcers in Severe Liver Disease: Outcomes and Management

“…PEBU is of unclear etiology, with varied risk factors and undefined clinical outcomes 5. Remarkably, there is no clinical or endoscopic classification based on the morphology of these lesions (ulcers), or which associates endoscopic appearance with clinical outcomes.…”

“…The available literature, in various case series and reports, suggests that PEBU occurs at rates of 2% to 10%,5–7 but there is no prospective data for incidence or risk factors. Studies have proposed that PEBU may be caused by reflux of gastric acid into the lower esophagus, leading to exposure of ulcer(s) and underlying vein(s) to the acid.…”

“…Alternate explanations include slippage of bands, infection of ulcers, and coagulopathy that leads to increased bleeding. Studies have indicated increased risks associated with the number of deployed bands, size of varices, severity of liver failure, or if the endoscopy was performed in an intensive care or emergency setting 5,7…”

Secondary prevention of esophageal varicose veins bleeding by means of modified endoscopic ligation technique

“…Данные осложнения могут длительно сохраняться и вызывать выраженный дискомфорт у некоторых пациентов, тем самым снижая качество жизни. Самым серьезным осложнением эндоскопического лигирования ВРВ считается постлигатурное кровотечение в раннем послеоперационном периоде [14], а также кровотечение из язв, возникших после отхождения некротизированных узлов на 6-е сутки, встречающееся в 7-8% случаев [15]. Еще одно значимое осложнение -рубцовая стриктура пищевода, которая чаще возникает при неправильной технике лигирования и встречается относительно редко -у 0,5-5,0% пациентов.…”