INCIDENCE AND OUTCOMES OF ENDOSCOPIC ESOPHAGEAL VARICEAL LIGATION-INDUCED ULCER BLEEDING

Aims:

Our aim is to assess the incidence, risk factors and outcomes of post-ligation hemorrhage.

Methods:

Retrospective multicenter study. Patients treated with elective band ligation between January 2013 and December 2015 in three centers were included and each treatment session was analyzed. Clinical, endoscopic and analytical variables were collected.

Results:

297 banding sessions in 133 patients were included. The average number of sessions was 3 per patient with an average of 5 bands. Twelve patients developed eschar bleeding, which represents an incidence of 9% and a 4% between the treatment sessions. Three patients required endoscopic treatment with adrenaline and/or sclerosis injection and another patient also required combined treatment adding hemoclips and Endoclot. The 90% required transfusion of 1.3 ± 0.8 red blood cell concentrates. The patients who bled had a mean age of 59 years, 10 patients (83.3%) were males. 5 of the 12 patients (41.7%) presented bleeding after the second banding session, 66.7% had signs of hypertensive gastropathy and 41.7% red spots on varicose veins. Regarding the Child-Pugh stage, 41.7% were Child A and B and 16.7% C. 25% had portal thrombosis and 41.7% had ascites at the time of endoscopy. 58.3% were in treatment with PPI and 50% with beta-blockers. An average 4 ± 2 band were placed. The mean platelet count was 81 ± 40 × 10⁹/L, albumin 38 ± 5 g/L and INR of 1.2 ± 0.2 ratio. We found no statistically significant differences.

Conclusions:

Prophylaxis of bleeding from esophageal varices with band ligation has a 9% incidence of bleeding from eschar. A 33% of the bleeding patients required endoscopic treatment, 90% transfusion of packed red blood cells and there was no death. No clinical, analytical or endoscopic factors have been associated with an increased risk of bleeding from eschar.