Bleeding due to Ligation Ulcers After Esophageal Varices Endoscopic Band Ligation

Aims Bleeding due to ligation ulcers (BLU) is a complication of endoscopic band ligation (EBL), performed in patients with portal hypertension (PHT). As it may be associated to a poor prognosis, it is relevant to discriminate which individuals are at higher risk of BLU. Aim: To evaluate the existence of predictors for BLU occurrence.

Methods This is a retrospective study of patients included in an EBL program for prevention of bleeding in a tertiary hospital in 2018-2019. Data was obtained from clinical record’s analysis. BLU was considered when patients were evaluated in the hospital for upper gastrointestinal bleeding.

Results Seventy-six patients were included (80.3 % men, median age 59 years); 65.8 % were on secondary prevention of bleeding. The cause of PHT was liver cirrhosis in 88.2 % of patients, who had a Child-Pugh score (CPs) of A-50 %, B- 40.6 % and C-9.4 %. Fifteen patients (19.7 %) had hepatocellular carcinoma and 19 (25 %) portal vein thrombosis. Patients underwent a median of 3 EBL sessions and were placed a median of 4 elastic bands per session [1-15].

BLU occurred in 5.3 % of patients (n = 4) and 1.5 % of sessions. It occured 14.5 days (median) after the previous EBL session and resulted in an hemoglobin drop of 1-2 g/dL. Compared to patients without this complication, it was found that they had higher platelet count (158,000 vs. 83,000, p = 0.043), with no differences in the remaining parameters evaluated: number of elastic bands placed (p = 0.216), type of prevention (p = 0.138), CPs (p = 0.932) or INR (p = 0.747). Among patients with BLU, two were hospitalized for vasopressor treatment; the third patient left the Emergency Department and the fourth was already hospitalized when BLU occurred and died due to acute-on-chronic liver failure.

Conclusions In our series, BLU was uncommon and was associated with a lower thrombocytopenia degree.

Citation: Gamelas V, Saraiva R, Simões G et al. eP49 BLEEDING DUE TO LIGATION ULCERS AFTER ESOPHAGEAL VARICES ENDOSCOPIC BAND LIGATION. Endoscopy 2021; 53: S112.

Publication History

Article published online:
19 March 2021