Endoscopy 2011; 43: E259
DOI: 10.1055/s-0030-1256522
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Complete esophageal occlusion after band ligation

S.  W.  de Melo1
  • 1University of South Alabama, Mobile, Alabama, USA
Further Information

Publication History

Publication Date:
11 August 2011 (online)

Esophageal variceal ligation (EVL) is commonly used to treat esophageal varices given its safety profile [1]. We report an unusual complication of EVL, complete esophageal obstruction, managed with the use of a clear cap attached to the gastroscope using a “can opener” maneuver.

An 84-year-old white woman with primary biliary cirrhosis intolerant to β-blockers underwent prophylactic EVL using the seven-shooter multiband ligator (Boston Scientific Inc., Natick, Massachusetts, USA) ([Fig. 1]). On arriving home, she reported inability to tolerate even water. Repeat upper endoscopy demonstrated complete esophageal obstruction with a single band ([Fig. 2]). Multiple attempts to remove the band using the endoscope, snare, and biopsy forceps were unsuccessful. A clear-cap (D-201 – 11 304, Olympus Inc., Tokyo, Japan) fitted gastroscope was then used to secure one side of the band and, just like the movement to remove a cap from a bottle, dislodge the band ([Fig. 3]). The patient returned 6 days later with similar complaints. An esophagogram showed a distal esophageal obstruction ([Fig. 4]). Repeat endoscopy demonstrated necrotic tissue occluding the esophagus, which was managed by dilation with a through the scope balloon and insertion of a nasoenteral feeding tube. After 2 weeks the nasoenteral feeding tube was removed and the esophageal stricture dilated to 15 mm ([Fig. 5]). The patient is now eating without restrictions and has remained asymptomatic for 6 months.

Fig. 1 Small esophageal varices seen on endoscopy.

Fig. 2 Complete esophageal ligation.

Fig. 3 Clear cap and the removed band.

Fig. 4 Gastrografin esophagogram with distal esophageal “ring.”

Fig. 5 Esophageal stricture after dilation.

Complete esophageal occlusion is a rare complication of EVL, however, removal of the occluding band may be challenging [3] [4] [5]. We report the novel use of a clear cap to successfully dislodge the band and relieve the obstruction.



S. W. de Melo Jr

University of South Alabama

5600 Girby Road
AL 36693

Email: demelo@usouthal.edu