title: Rates of recurrent variceal bleeding are low with modern esophageal banding strategies: a retrospective cohort study.
abstract: BACKGROUND
  Variceal bleeding has a high rate of mortality and recurrence. Endoscopic band ligation (EBL) is the established standard of care for secondary prevention of variceal bleeding.
  
  
  OBJECTIVE
  To determine the long-term re-bleeding rate of an EBL protocol similar to current society guidelines.
  
  
  METHODS
  We conducted a retrospective cohort study at a tertiary care center of all patients with a history of a variceal bleed who underwent an aggressive band ligation protocol.
  
  
  METHODS
  At the time of sentinel bleed, all varices, regardless of size, were ligated. EBL was then repeated every 2 weeks until stabilization, and all visible varices were ligated. The interval between banding sessions then increased.
  
  
  METHODS
  The incidence of re-bleeding was calculated as the time between clinical stabilization after the sentinel event until data censoring, which occurred at time of re-bleed, death, transplant or loss-to-follow up. Gastric variceal bleeding was a secondary endpoint.
  
  
  RESULTS
  N = 176 patients were treated with aggressive EBL, and followed for a median of 16 months (range, 3 months - 6.9 years). The 6 month incidence of re-bleeding was 2.3%, the 12 month incidence was 3.4%, and the 2 year incidence was 4.6%. Overall, aggressive EBL was well-tolerated. One patient died during follow-up secondary to a gastric variceal bleed.
  
  
  CONCLUSIONS
  Aggressive EBL yields a low rate of re-bleeding when compared to standard practice. Secondary prophylaxis with aggressive EBL should be a consideration for patients following a sentinel bleeding event.
authors: Department of Medicine, Division of Infectious Diseases, Eastern Colorado VA Healthcare System and University of Colorado School of Medicine , Denver, CO , USA.
authors: Westyn
authors: W
authors: Branch-Elliman
authors: Ponni
authors: P
authors: Perumalswami
authors: Stephanie H
authors: SH
authors: Factor
authors: Sarah M
authors: SM
authors: Sled
authors: Steven L
authors: SL
authors: Flamm
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D004724:Endoscopy / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008026:Ligation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000592:standards*; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: band ligation; secondary prophylaxis; variceal bleeding