PREDICTORS OF POST BANDING-ULCER BLEEDING AFTER ENDOSCOPIC VARICEAL LIGATION

Aims Bleeding related to post banding-ulcer is a rare life-threatening complication of endoscopic variceal ligation (EVL) in cirrhotic patients with esophageal varices (EV). The aim of this study was to determine the incidence and predictive factors of EVL induced ulcer bleeding.

Methods We performed a retrospective single study center including cirrhotic patients undergoing EVL in prophylaxis or acute hemorrhage of esophageal varices between 2014 and 2018. The diagnosis of EVL-induced ulcer bleeding was made endoscopically showing bleeding from an ulcer due to the slippage of the rubber band.

Results A total of 89 consecutive patients were included with a sex ratio of M/F of 1.02. The mean age was 61 years ± 11 [20–64]. The Child-Pugh classification of enrolled patients was A in 34 (38.2%) patients, B in 44 (49.4%) patients, and C in 11 (12.3%) patients. The form of EV was classified as F1 in one (1.1%) patient, F2 in 23 (25.8%) patients and F3 in 65 (73%) patients. EVL was indicated for primary prophylaxis in 11.2 % of cases and for secondary prophylaxis in 88.8 % of cases. Ulcer bleeding following EVL was observed in 4 patients (4.49%).The mean interval between EVL and bleeding was 6.8 ± 5.07 days. Independent predictors of ulcer related bleeding were MELD score > 15 at admission (p = 0.04), concomitant gastric varices (p = 0.047) and low platelet to spleen diameter ratio (p = 0.02). In our study high APRI score, peptic oesophagitis and low prothrombin time index were not significantly associated to EVL-induced ulcer bleeding.

Conclusions Post-banding ulcer bleeding is a severe and not common complication of EVL. Patients with high MELD score, low platelet to spleen diameter ratio or concomitant gastric varices should be observed for signs of induced ulcer bleeding after EVL.