Esophageal Dislodgment of a Reused Variceal Ligator Cap: A Complication of Endoscopic Variceal Ligation

We read with interest the article by Wai et al. on esophageal dislodgment of a variceal ligator cap [1]. Recent issues of Endoscopy have carried reports of esophageal dislodgment of ligator caps that has occurred because of a mismatch of sizes between the ligator cap and the endoscope diameter [1] [2].

We have encountered dislodgment of an appropriately sized but reused plastic tip of a ligator cap during an esophageal variceal ligation. The gastroscope (GIF-Q140; Olympus, Tokyo, Japan) had an external diameter of 10.5 mm and the ligator cap (Saeed MBL-6 Shooter; Wilson-Cook, Winston-Salem, North Carolina, USA) had a fitting diameter of between 9.5 mm and 13 mm. The plastic tip was retrieved successfully with rat-tooth foreign-body forceps (Figures [1], [2]). We attribute the dislodgment in our case to the reuse of the ligator cap, which had been disinfected 30 minutes in 2 % glutaraldehyde solution before the procedure. This practice is safe with regard to avoiding transmission of infection [3].

Figure 1 The dislodged Opti-Vu barrel was successfully removed using rat-tooth foreign body forceps.

Figure 2 The reused variceal ligator cap after the procedure.

Wai et al. emphasized the importance of routine checking of models and sizes of endoscopes and ligator caps before performing any variceal band ligation [1]. We would also alert endoscopists to the risk of esophageal dislodgment of a band ligator cap that is being reused, even when its diameter is compatible with that of the gastroscope.

References

• 1 Wai C T, Ho K Y, Kwok F Y. Esophageal dislodgment of a variceal ligator cap due to size mismatch between the ligator cap and the endoscope.  Endoscopy. 2003;  35 191
• 2 Syn W K, Skander M P, Ahmed M M. Variceal ligator cap dislodgment, and retrieval techniques.  Endoscopy. 2003;  35 794
• 3 Wilkinson M, Simmons N, Brambi F M. et al . Report of the working party of the Endoscopic Committee of the British Society of Gastroenterology on the reuse of endoscopic accessories.  Gut. 1998;  42 304-306