Download PDF
CC BY 4.0 · Endoscopy 2024; 56(S 01): E211-E212
DOI: 10.1055/a-2268-5513
E-Videos

Band-on-band endoscopic variceal ligation: a technique for the treatment of esophageal varices in case of band misplacement

Andrea Sorge 
1   Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
,
Tommaso Pessarelli 
1   Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
,
Luca Elli 
2   Gastroenterology and Endoscopy Unit, Fondazione IRCCS Caʼ Granda Ospedale Maggiore Policlinico, Milan, Italy (Ringgold ID: RIN9339)
,
Nicoletta Nandi 
1   Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
,
Giulia Tosetti
3   Gastroenterology and Hepatology Unit, Fondazione IRCCS Caʼ Granda Ospedale Maggiore Policlinico,
,
Massimo Primignani
3   Gastroenterology and Hepatology Unit, Fondazione IRCCS Caʼ Granda Ospedale Maggiore Policlinico,
,
Gian Eugenio Tontini
2   Gastroenterology and Endoscopy Unit, Fondazione IRCCS Caʼ Granda Ospedale Maggiore Policlinico, Milan, Italy (Ringgold ID: RIN9339)
1   Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
› Author AffiliationsThis study was partially funded by the Italian Ministry of Health, Current research IRCCS, year 2023.
› Further Information
Also available at
   Permissions and Reprints

A 62-year-old woman with porto-sinusoidal vascular disorder and portal hypertension was admitted to the emergency department for hematemesis and anemia (hemoglobin 8.1 mg/dL). Five years ago, she had been treated at another hospital with two sessions of endoscopic variceal ligation (EVL) for esophageal variceal bleeding. After hemodynamic stabilization, an upper gastrointestinal endoscopy was performed and large-caliber esophageal varices with red signs were found in the middle and lower third of the esophagus. There was no active bleeding. EVL (Speedband Superview Super 7; Boston Scientific, Marlborough, Massachusetts, United States) was performed [1], but the placement of one of the bands failed due to poor tissue elevation, causing accidental oozing bleeding. Another band was promptly placed achieving hemostasis, but the position of the band was suboptimal due to inadequate tissue elevation. The small amount of variceal tissue grasped by the band could have caused premature band dislodgement and severe post-banding ulcer bleeding. Therefore, we placed the banding cap over the misplaced band ([Fig. 1]) and applied prolonged suction to achieve maximal tissue prolapse inside the banding cap ([Video 1]). Finally, we placed a new band below the previous one ([Fig. 2]). Such band-on-band EVL was successful, achieving optimal band placement without residual bleeding. No further adverse events occurred and the patient was discharged home 4 days after admission. At a 1-month follow-up visit, no adverse events or rebleeding were reported.

Zoom Image
Fig. 1 Banding cap applied over the misplaced band.

Quality:
Band-on-band endoscopic variceal ligation in a patient with incomplete variceal suction and band misplacement.Video 1

Zoom Image
Fig. 2 Optimal band placement after band-on-band ligation.

The success rate of EVL is about 85–94% [2] [3] with incomplete suction due to fibrosis from previous endoscopic treatments being one of the major causes of failure [4]. This case describes for the first time the band-on-band EVL technique, a safe and effective method for the management of band misplacement during EVL. Band-on-band EVL could be a valid option to ensure optimal and durable treatment for incomplete variceal suction and band misplacement cases.

Endoscopy_UCTN_Code_TTT_1AO_2AD

Endoscopy E-Videos https://eref.thieme.de/e-videos

E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).

This section has its own submission website athttps://mc.manuscriptcentral.com/e-videos.



Publication History

Article published online:
01 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Letter to this article:

Comments on “Band-on-band endoscopic variceal ligation: a technique for the treatment of esophageal varices in case of band misplacement”Endoscopy 2025; 57(01): 90-90
DOI: 10.1055/a-2386-9001

 

  • References

  • 1 Gralnek IM, Camus Duboc M, Garcia-Pagan JC. et al. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54: 1094-1120
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Stiegmann GV, Goff JS, Michaletz-Onody PA. et al. Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. N Engl J Med 1992; 326: 1527-1532
    CrossrefPubMedSearch in Google Scholar
  • 3 Lo GH, Lai KH, Cheng JS. et al. A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices. Hepatology 1995; 22: 466-471
    CrossrefPubMedSearch in Google Scholar
  • 4 Kim DH, Cho E, Jun CH. et al. Risk factors and on-site rescue treatments for endoscopic variceal ligation failure. Korean J Gastroenterol 2018; 72: 188-196
    CrossrefPubMedSearch in Google Scholar