Interventions and outcomes of treatment of postbanding ulcer hemorrhage after endoscopic band ligation: a single-center case series

Tierney, Amber; Toriz, Bertha E.; Mian, Somia; Brown, Kyle E.

doi:10.1016/j.gie.2012.08.031

Cited by 22 publications

(39 citation statements)

References 21 publications

(40 reference statements)

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“…When the EVL indication is considered, rebleeding occurs more frequently after emergency than elective ligation. [17,18] Although uncommon, the mortality rate is up to 52%, mainly due to infectious complications. [19] Our group is conducting a controlled prospective trial aiming to analyze outcomes after treatment of osteoporosis or osteopenia in cirrhotic patients (119 subjects) with esophageal varices.…”

Section: Epidemiologymentioning

confidence: 99%

“…[7,18,20] In addition, prior variceal digestive bleeding, high platelet ratio index (APRI score), peptic esophagitis and low prothrombin index are also deemed bleeding risk factors after early spontaneous slippage of the EVL rubber band. [19] However, it remains controversial whether coagulation status predicts bleeding after EVL.…”

Section: Risk Factorsmentioning

confidence: 99%

“…[17,18] In elective procedures, higher MELD score and reflux esophagitis were associated with significant EVLinduced ulcer hemorrhage. [23] The number of rubber bands applied per patient seems to have no correlation with rebleeding in most trials.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Among 991 banding sessions and 23 post-banding ulcer bleeding events, only six were effectively treated with octreotide infusion + PPI +/-sucralfate. [18] Perhaps this combination of drugs merits future studies.…”

Section: Risk Factorsmentioning

confidence: 99%

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Diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band ligation ulcer in cirrhotic patients

Lima

Silva

Romeiro

2018

CRIM

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Esophageal varices develop in half of cirrhotic patients. Endoscopic variceal band ligation is the current treatment for acute bleeding and applicable for primary and secondary prophylaxis. However, there is a risk of complications, including ligationinduced ulcer bleeding. The aim of this study is to review the current diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band-ligation ulcers in cirrhotic patients. PubMed and Google Scholar were searched for English language articles about the theme. The main findings were that Child-Pugh class C, higher model of end-stage liver disease, emergency ligation, presence of hepatocellular carcinoma, peptic esophagitis and bacterial infection were reported as the most important risk factors for post-banding ulcer hemorrhage. There are few studies with proton pump inhibitors and sucralfate showing size reduction of post-banding ulcers. Many treatment modalities have been used to control post band ulcer bleeding, such as band local injection of epinephrine or cyanoacrylate, balloon tamponade, stent placement and ligation of the ulcerated bleeding site. However, the optimal management remains uncertain. The principal conclusions of the study were that post-banding ulcer bleeding is potentially life-threatening and must be suspected in the presence of hematemesis, melena or anemia after endoscopic variceal band ligation (EVL). Predictors of rebleeding must be assessed and controlled as much as possible before band ligation. The post-banding treatment with proton pump inhibitors or sucralfate seems advisable, in particular for high-risk patients. Further investigation and new approaches are still required to achieve optimal management of this complication.

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Section: Epidemiologymentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

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Diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band ligation ulcer in cirrhotic patients

Lima

Silva

Romeiro

2018

CRIM

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“…1 The bleeding from post-EVL ulcers can be managed by pharmacotherapy; endoscopic banding or sclerotherapy, and transjugular intrahepatic portosystemic shunt (TIPSS). 2 The index patient has failed endoscopic approach and pharmacotherapy. TIPSS was not feasible as he was post-living donor liver transplant and right hepatic vein was main venous drainage, which would have been compromised by the stent.…”

mentioning

confidence: 99%

Innovative Approach of Using Esophageal Stent for Refractory Post-Band Ligation Esophageal Ulcer Bleed Following Living Donor Liver Transplantation

Choudhary

Puri

Saigal

et al. 2016

Journal of Clinical and Experimental Hepatology

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Bleeding from post-banding esophageal ulcers is uncommon. It is associated with significant morbidity and mortality. The bleeding from post-banding ulcers is difficult to manage and may be refractory to endotherapy and pharmacological treatment; transjugular intrahepatic portosystemic shunt can be used in such cases. We present a case of refractory post-banding ulcer bleed in a liver transplant recipient, which was managed by placement of removable esophageal metal stent. ( J CLIN EXP HEPATOL 2016;6:149-150) A 54-year-old male had right lobe living donor liver transplantation for cryptogenic cirrhosis and decompensation (ascites, variceal bleed, hepatorenal syndrome). He was diagnosed as having cirrhosis 10 years back when he had variceal bleed. He had ascites for 1 year and his comorbidities included diabetes for 10 years with diabetic nephropathy (proteinuria) and hypothyroidism. He had variceal bleed 14 days before transplantation for which esophageal variceal banding was done. His CTP score was 8 and MELD score was 14 at the time of transplantation. A decision of early liver transplantation was taken in view of fluctuating renal function tests, which were normal at the time of transplantation. He had melena and fall of hemoglobin on postop day 8 (day 22 of variceal banding). An esophagogastroscopy was done, which showed post-endoscopic variceal ligation (EVL) ulcers and active ooze from one ulcer (as shown in Figure 1), for which sclerotherapy was done using sodium tetradecyl sulfate. He received inj. Terlipressin and blood transfusions. However, he continued to have melena and fall in hemoglobin; repeat gastroscopy next day showed ooze from the same site, which could not be controlled by endoscopic sclerotherapy. Option of esophageal fully covered self-expanding metallic stent (SEMS) was discussed with family, and after due consent, a Danis stent (13 cm length, diameter 30 mm at both ends, 25 mm in between, made by Ella, Kravlov, Czech Republic) was placed as shown in Figure 2. The patient remained hemodynamically stable. His chest X-ray done on the next day showed partially migrated stent in stomach, which was repositioned by pulling the Lasso attached to stent and upper end of stent was subsequently anchored with hemoclips. A feeding tube was placed in view of poor oral intake. A check endoscopy showed no bleed from any site with stent in situ (Figure 3). The patient did not have any further bleed. The stent was removed on 16th day after its placement. DISCUSSIONBleeding from post-EVL ulcers is uncommon. In a large study of 749 episodes of EVL (140 for acute hemorrhage), the authors reported 21 episodes (2.8%) of post-EVL ulcer bleed, five of whom subsequently died (28%). The authors found that acute variceal hemorrhage was the only significant factor for post-EVL ulcer bleed on multivariate Figure 1 Post-EVL ulcer with clot and fresh blood in esophageal lumen.

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Endoscopic and Pharmacological Treatment of Esophageal Varices

2020

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Interventions and outcomes of treatment of postbanding ulcer hemorrhage after endoscopic band ligation: a single-center case series

Cited by 22 publications

References 21 publications

Diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band ligation ulcer in cirrhotic patients

Diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band ligation ulcer in cirrhotic patients

Innovative Approach of Using Esophageal Stent for Refractory Post-Band Ligation Esophageal Ulcer Bleed Following Living Donor Liver Transplantation

Endoscopic and Pharmacological Treatment of Esophageal Varices

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