Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis.
BACKGROUND
Endoscopic band ligation (EBL) is generally accepted as the treatment of choice for bleeding from esophageal varices. It is also used for secondary prophylaxis of esophageal variceal hemorrhage. However, there is no data or guidelines concerning endoscopic control of ligation ulcers. We conducted a retrospective study of EBL procedures analyzing bleeding complications after EBL.


METHODS
We retrospectively analyzed data from patients who underwent EBL. We analyzed several data points, including indication for the procedure, bleeding events and the time interval between EBL and bleeding.


RESULTS
255 patients and 387 ligation sessions were included in the analysis. We observed an overall bleeding rate after EBL of 7.8%. Bleeding events after elective treatment (3.9%) were significantly lower than those after treatment for acute variceal hemorrhage (12.1%). The number of bleeding events from ligation ulcers and variceal rebleeding was 14 and 15, respectively. The bleeding rate from the ligation site in the group who underwent emergency ligation was 7.1% and 0.5% in the group who underwent elective ligation. Incidence of variceal rebleeding did not vary significantly. Seventy-five percent of all bleeding episodes after elective treatment occurred within four days after EBL. 20/22 of bleeding events after emergency ligation occurred within 11 days after treatment. Elective EBL has a lower risk of bleeding from treatment-induced ulceration than emergency ligation.


CONCLUSIONS
Patients who underwent EBL for treatment of acute variceal bleeding should be kept under medical surveillance for 11 days. After elective EBL, it may be reasonable to restrict the period of surveillance to four days or even perform the procedure in an out-patient setting.
Petrasch
Florian
F
Department of Internal Medicine II, University of Leipzig, 04103 Leipzig, Germany.
Grothaus
Johannes
J
Mössner
Joachim
J
Schiefke
Ingolf
I
Hoffmeister
Albrecht
A
D004630:Emergencies; D016099:Endoscopy, Gastrointestinal / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008026:Ligation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies