© Georg Thieme Verlag KG Stuttgart · New York
Complete esophageal occlusion after band ligation
11 August 2011 (online)
Esophageal variceal ligation (EVL) is commonly used to treat esophageal varices given its safety profile . 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   . We report the novel use of a clear cap to successfully dislodge the band and relieve the obstruction.
- 1 Garcia-Tsao G, Sanyal A J, Grace N D, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007; 46 922-938
- 2 Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med. 2010; 362 823-832
- 3 Nawaz A, Sarwar S, Batul A. Complete esophageal occlusion following esophageal variceal band ligation: an unusual complication; a case report. Visible Human Journal of Endoscopy. 2010; 9 1-4
- 4 Verma D, Pham C, Madan A. Complete esophageal obstruction: an ususual complication of esophageal variceal ligation. Endoscopy. 2009; 41 Suppl 2 E200-201
- 5 Rai R R, Nijhawan S, Singh G. Post-ligation stricture: a rare complication. Endoscopy. 1996; 28 406
S. W. de Melo Jr
University of South Alabama
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