Predictive factors of bleeding related to post‐banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case‐control study

Abstract

SUMMARY BackgroundLife-threatening bleeding caused by early spontaneous slippage of rubber bands has been described after variceal ligation in cirrhotic patients.

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

“…In a study of 605 patients undergoing variceal ligation, 21 (3.5%) patients had spontaneous bleeding due to band slippages confirmed at endoscopy, and 11 died. 198 Rebleeding due to band-induced ulcers has been found to occur in up to 14% of patients. [199][200][201][202] Multivariate analysis in the first study found no increased risk of bleeding in those on aspirin, although this applied to only 8/605 patients.…”

“…[199][200][201][202] Multivariate analysis in the first study found no increased risk of bleeding in those on aspirin, although this applied to only 8/605 patients. 198 There have been no studies of the risks of haemorrhage following variceal banding in patients on thienopyridenes, ticagrelor or DOAC, and indeed it would be usual to discontinue these drugs, if possible, in a population at such a high risk of haemorrhage.…”

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

“…[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.…”

“…[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. Until now only 17 patients required 26 EVL sessions (Child-Pugh classes A, B and C were 6, 10 and 1, respectively).…”

“…[43] Vanbiervliet et al analyzed predictive factors of hemorrhage related to post-banding ulcer and did not find any benefits from sucralfate usage for bleeding prevention, despite the low number of subjects evaluated. [19] In 2011, a randomized, double-blinded, placebo-controlled trial included 31 patients who received sucralfate after EVL (1 gram every 6 hours for 2 weeks). The placebo group was also composed of 31 patients.…”