title: Predictive factors of bleeding related to post-banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case-control study.
abstract: BACKGROUND
  Life-threatening bleeding caused by early spontaneous slippage of rubber bands has been described after variceal ligation in cirrhotic patients.
  
  
  OBJECTIVE
  To determine the predictive factors of this complication in cirrhotic patients.
  
  
  METHODS
  Among 605 patients, 21 patients (mean age 56.6 +/- 13.5 years) developed 23 spontaneous band slippages with bleeding on post banding ulcer, as confirmed by endoscopy. Cirrhosis was alcoholic in 13 patients (62%), post viral hepatitis in three (14%) and from other causes in five (24%). A case-control study was performed comparing 17 from these patients who presented the complication after a first ligation with 84 of the 584 controls who underwent first endoscopic variceal ligation without bleeding complication.
  
  
  RESULTS
  Bleeding occurred 13.5 days +/- 7.3 (2-29) following ligation. Eleven patients died following the bleeding complication (52%). Using a multivariate analysis, previous upper variceal digestive bleeding [OR 12.07, 95%CI (2.3-63.43)], peptic oesophagitis [OR 8.9, 95%CI (1.65-47.8)], high platelet ratio index (APRI) score [OR 1.54, 95%CI (1.11-2.16)] and low prothrombin index [OR 0.54, 95% CI (0.31-0.94)] were independent predictive factors of bleeding.
  
  
  CONCLUSIONS
  Bleeding related to post-banding ulcer is a rare, but severe complication. The proposed predictive factors should be looked for and minimized before variceal ligation.
authors.affiliation: Faculté de Médecine, Université de Sophia-Antipolis, Nice, F-06107, France. vanbiervliet.g@chu-nice.fr
authors.forename: G
authors.initials: G
authors.lastname: Vanbiervliet
authors.forename: S
authors.initials: S
authors.lastname: Giudicelli-Bornard
authors.forename: T
authors.initials: T
authors.lastname: Piche
authors.forename: F
authors.initials: F
authors.lastname: Berthier
authors.forename: E
authors.initials: E
authors.lastname: Gelsi
authors.forename: J
authors.initials: J
authors.lastname: Filippi
authors.forename: R
authors.initials: R
authors.lastname: Anty
authors.forename: K
authors.initials: K
authors.lastname: Arab
authors.forename: P M
authors.initials: PM
authors.lastname: Huet
authors.forename: X
authors.initials: X
authors.lastname: Hebuterne
authors.forename: A
authors.initials: A
authors.lastname: Tran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D013276:Stomach Ulcer / Q000150:complications*; D016896:Treatment Outcome