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

Abstract

B Acute variceal hemorrhage is a significant cause of morbidity and mortality in cirrhotic patients.1 Endoscopic and ligation (EBL) is the preferred treatment for acute ariceal hemorrhage and is used for the primary and secndary prophylaxis of esophageal variceal bleeding.2-4 Complications after EBL occur in 2% to 23.7% of patients and include esophageal stricture formation, infection, and rebleeding caused by variceal hemorrhage or postbanding ulcers.2-7 The reported incidence of bleeding from postanding ulcers alone is 2.6% to 7.3%.2,6-11 EBL commonly produces shallow, circular ulcerations with large surface areas.12 When a ligation band is placed, it interrupts blood supply to the entrapped tissue and causes coagulative necrosis of the tissue and thrombosis of adjacent varices.13 Sloughing of the necrotic tissue often creates an ulcer that typically heals within 2 to 3 weeks without complication.12,14 However, if band detachment occurs before variceal thrombosis, an ulcer can form with the underlying vessels exposed, leading to severe and fatal hemorrhage.15,16 Postbanding ulcer hemorrhage (PBUH) is reported to occur most commonly between 2 and 29 days after EBL,8-10,15,16 but may occur as early as day 0 because of ischemic necrosis and epithelial sloughing of the mucosa.17 Identified risk factors for PBUH include Child-Pugh class C status, high platelet ratio index, low prothrombin index, and EBL for acute variceal bleeding.8-10 Various