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Interventions and outcomes of treatment of postbanding ulcer hemorrhage after endoscopic band ligation: a single-center case series

  • Amber Tierney
    Correspondence
    Reprint requests: Amber Tierney, MD, 2210 Richert Place, St. Louis, MO 63143
    Affiliations
    Department of Internal Medicine, Washington University, St. Louis, Missouri
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  • Bertha E. Toriz
    Affiliations
    Division of Gastroenterology-Hepatology, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
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  • Somia Mian
    Affiliations
    Division of Gastroenterology-Hepatology, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
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  • Kyle E. Brown
    Affiliations
    Division of Gastroenterology-Hepatology, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa

    Program in Free Radical and Radiation Biology, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa

    Iowa City Veterans Administration Medical Center, Iowa City, Iowa
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Published:October 12, 2012DOI:https://doi.org/10.1016/j.gie.2012.08.031
Interventions and outcomes of treatment of postbanding ulcer hemorrhage after endoscopic band ligation: a single-center case series
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      Acute variceal hemorrhage is a significant cause of morbidity and mortality in cirrhotic patients.
      North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices
      Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices.
      N Engl J Med. 1988; 319: 983-989
      Endoscopic band ligation (EBL) is the preferred treatment for acute variceal hemorrhage and is used for the primary and secondary prophylaxis of esophageal variceal bleeding.
      • Laine L.
      • el-Newihi H.M.
      • Migikovsky B.
      • et al.
      Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices.
      Ann Intern Med. 1993; 119: 1-7
      , 
      • Stiegmann G.V.
      • Goff J.S.
      • Michaletz-Onody P.A.
      • et al.
      Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices.
      N Engl J Med. 1992; 326: 1527-1532
      , 
      • Garcia-Tsao G.
      • Sanyal A.J.
      • Grace N.D.
      • et al.
      Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis.
      Hepatology. 2007; 46: 922-938
      Complications after EBL occur in 2% to 23.7% of patients and include esophageal stricture formation, infection, and rebleeding caused by variceal hemorrhage or postbanding ulcers.
      • Laine L.
      • el-Newihi H.M.
      • Migikovsky B.
      • et al.
      Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices.
      Ann Intern Med. 1993; 119: 1-7
      , 
      • Stiegmann G.V.
      • Goff J.S.
      • Michaletz-Onody P.A.
      • et al.
      Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices.
      N Engl J Med. 1992; 326: 1527-1532
      , 
      • Garcia-Tsao G.
      • Sanyal A.J.
      • Grace N.D.
      • et al.
      Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis.
      Hepatology. 2007; 46: 922-938
      , 
      • Lay C.S.
      • Tsai Y.T.
      • Lee F.Y.
      • et al.
      Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis.
      J Gastroenterol Hepatol. 2006; 21: 413-419
      , 
      • Norberto L.
      • Polese L.
      • Cillo U.
      • et al.
      A randomized study comparing ligation with propranolol for primary prophylaxis of variceal bleeding in candidates for liver transplantation.
      Liver Transpl. 2007; 13: 1272-1278
      , 
      • Schepke M.
      • Kleber G.
      • Nürnberg D.
      • et al.
      Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhotics.
      Hepatology. 2004; 40: 65-72
      The reported incidence of bleeding from postbanding ulcers alone is 2.6% to 7.3%.
      • Laine L.
      • el-Newihi H.M.
      • Migikovsky B.
      • et al.
      Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices.
      Ann Intern Med. 1993; 119: 1-7
      , 
      • Norberto L.
      • Polese L.
      • Cillo U.
      • et al.
      A randomized study comparing ligation with propranolol for primary prophylaxis of variceal bleeding in candidates for liver transplantation.
      Liver Transpl. 2007; 13: 1272-1278
      , 
      • Schepke M.
      • Kleber G.
      • Nürnberg D.
      • et al.
      Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhotics.
      Hepatology. 2004; 40: 65-72
      , 
      • Vieira da Rocha E.C.
      • D'Amico E.A.
      • Caldwell S.H.
      • et al.
      A prospective study of conventional and expanded coagulation indices in predicting ulcer bleeding after variceal band ligation.
      Clin Gastroenterol Hepatol. 2009; 7: 988-993
      , 
      • Petrasch F.
      • Grothaus J.
      • Mössner J.
      • et al.
      Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis.
      BMC Gastroenterol. 2010; 10: 5
      , 
      • Vanbiervliet G.
      • Giudicelli-Bornard S.
      • Piche T.
      • et al.
      Predictive factors of bleeding related to post-banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case-control study.
      Aliment Pharmacol Ther. 2010; 32: 225-232
      , 
      • Schmitz R.J.
      • Sharma P.
      • Badr A.S.
      • et al.
      Incidence and management of esophageal stricture formation, ulcer bleeding, perforation, and massive hematoma formation from sclerotherapy versus band ligation.
      Am J Gastroenterol. 2001; 96: 437-441

      Abbreviations:

      EBL (endoscopic band ligation), MELD (Model for End-Stage Liver Disease), PBUH (postbanding ulcer hemorrhage), PPI (proton pump inhibitor), TIPS (transjugular intrahepatic portosystemic shunt)
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      References

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        Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices.
        N Engl J Med. 1988; 319: 983-989
        View in Article
        • Laine L.
        • el-Newihi H.M.
        • Migikovsky B.
        • et al.
        Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices.
        Ann Intern Med. 1993; 119: 1-7
        View in Article
        • Stiegmann G.V.
        • Goff J.S.
        • Michaletz-Onody P.A.
        • et al.
        Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices.
        N Engl J Med. 1992; 326: 1527-1532
        View in Article
        • Garcia-Tsao G.
        • Sanyal A.J.
        • Grace N.D.
        • et al.
        Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis.
        Hepatology. 2007; 46: 922-938
        View in Article
        • Lay C.S.
        • Tsai Y.T.
        • Lee F.Y.
        • et al.
        Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis.
        J Gastroenterol Hepatol. 2006; 21: 413-419
        View in Article
        • Norberto L.
        • Polese L.
        • Cillo U.
        • et al.
        A randomized study comparing ligation with propranolol for primary prophylaxis of variceal bleeding in candidates for liver transplantation.
        Liver Transpl. 2007; 13: 1272-1278
        View in Article
        • Schepke M.
        • Kleber G.
        • Nürnberg D.
        • et al.
        Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhotics.
        Hepatology. 2004; 40: 65-72
        View in Article
        • Vieira da Rocha E.C.
        • D'Amico E.A.
        • Caldwell S.H.
        • et al.
        A prospective study of conventional and expanded coagulation indices in predicting ulcer bleeding after variceal band ligation.
        Clin Gastroenterol Hepatol. 2009; 7: 988-993
        View in Article
        • Petrasch F.
        • Grothaus J.
        • Mössner J.
        • et al.
        Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis.
        BMC Gastroenterol. 2010; 10: 5
        View in Article
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        • Giudicelli-Bornard S.
        • Piche T.
        • et al.
        Predictive factors of bleeding related to post-banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case-control study.
        Aliment Pharmacol Ther. 2010; 32: 225-232
        View in Article
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        • Sharma P.
        • Badr A.S.
        • et al.
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        View in Article
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      Article info

      Publication history

      Published online: October 12, 2012
      Accepted: August 27, 2012
      Received: May 29, 2012

      Footnotes

      DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.

      Identification

      DOI: https://doi.org/10.1016/j.gie.2012.08.031

      Copyright

      © 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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