Role of endoscopic band ligation in management of non-variceal upper gastrointestinal bleeding

Abstract

Acute non-variceal upper GI bleeding (NVUGIB) is a challenging emergency condition. Early endoscopic therapy has been recommended as the first-line of treatment for upper GI bleeding (UGIB) as it has been shown to reduce recurrent bleeding. We aimed to determine the various causes of NVUGIB and discuss the role of band ligation. A total of 74 patients with NVUGIB who had been treated with endoscopic band ligation (EBL), between November 2006 and December 2011, were included in the study. Bleeding lesions included Dieulafoy lesion (DL), Mallory-Weiss tears (MWTs), duodenal ulcer, post-surgical anastomosis bleed and gastric ulcer after polypectomy. After the basic life support was provided, all patients underwent emergent and elective endoscopy. The study comprised 49 (66.2%) men and 25 (33.8%) women. The mean age was 48.2 +/- 6.4 years for men and 40.6 +/- 2.2 years for women. MWTs and DL constituted the majority of bleeding lesions, of these 26 and 17, respectively required EBL. Other causes were: prepyloric ulcer 11; duodenal ulcer 9; ulcers in antrum 5; post-polypectomy bleed 3; anastomosis bleed 1; and malignant lesions 2. Bleeding stopped after endoscopic therapy in 96.5% of patients. The single failure was in bleeding from a pre-pyloric lesion which was treated by using injection sclerotherapy with 1:10,000 adrenaline solution where EBL was not successful. EBL provides safe and effective modality for haemostasis in patients with NVUGIB. EBL could be considered as an alternative method of choice for treatment of endoscopic haemostasis in patients with NVGIB.