Frequency and Risk Factors of Post Banding Ulcer Bleeding Following Endoscopic Variceal Ligation in Patients with Liver Cirrhosis

Article 2Volume 9, Issue 4, December 2019, Page 252-259  

Document Type: Original Article

DOI: 10.21608/AEJI.2019.56710


Soha A Elhawari Description: email 1Emad A Moustafa1Tarek Zaher1Hany M Elsadek2Mahmoud A Abd-Elazeim1

1Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

2Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig,Egypt


Background and aim: Endoscopic variceal ligation (EVL) is one of the best modalities for treatment of esophageal varices. One of the most serious complications after EVL is post-banding ulcer bleeding. In this study, frequency and risk factors of EVL-induced ulcer bleeding were assessed.
Methods: One hundred and twenty six patients with liver cirrhosis subjected to EVL, whether done as prophylactic or therapeutic, were followed up for two weeks for detection of occurrence of post-banding ulcer bleeding. A prospective cohort study was performed comparing the patients that bleed after EVL due to post-banding ulcer (bleeder group, n= 10) with those without this complication (non-bleeder group, n= 116).
All patients received full medical history taking; complete physical examination; routine laboratory tests; Pelvi-abdominal ultrasonography; Esophago-gastro-duodenoscopy (EGD) and EVL; treatment with blood transfusion and pharmacologic agents; re-endoscopy if rebleeding occur after EVL.
Results: Frequency of post–banding ulcer bleeding after EVL in patients who have liver cirrhosis was 7.9%, and its mortality within 14 days follow up was 10%. Reflux esophagitis was found to be a risk factor of post- banding ulcer bleeding (P= 0.016, OR= 8). Proton pump inhibitor (PPI) may be a protective factor against occurrence of post-banding ulcer bleeding (P= 0.054).
Conclusion: Post-banding ulcer bleeding is an infrequent complication after EVL. Reflux esophagitis is considered an independent risk factor for this complication.


Endoscopic variceal ligation-EVLPost-banding ulcer bleedingrisk factor

Main Subjects