Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Removal of Esophageal Variceal Bands to Salvage Complete Esophageal Obstruction

  • Jalil, Ala' A Abdel (Division of Gastroenterology & Hepatology, University of Missouri-Columbia) ;
  • Hammoud, Ghassan (Division of Gastroenterology & Hepatology, University of Missouri-Columbia) ;
  • Ibdah, Jamal A (Division of Gastroenterology & Hepatology, University of Missouri-Columbia) ;
  • Samiullah, Sami (Division of Gastroenterology & Hepatology, University of Missouri-Columbia)
  • Received : 2017.12.26
  • Accepted : 2018.04.10
  • Published : 2018.09.30
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Abstract

Esophageal varices develop in almost half of the patients with cirrhosis, and variceal hemorrhage constitutes an ominous sign with an increased risk of mortality. Variceal banding is considered an effective and mostly safe measure for primary and secondary prophylaxis. Although adverse events related to banding including dysphagia, stricture formation, bleeding, and ligation-induced ulcers have been described, complete esophageal obstruction is rare, with only 10 reported cases in the literature. Among those cases, 6 were managed conservatively; 1 patient had esophageal intraluminal dissection from an attempt to remove the bands using biopsy forceps but ultimately recovered with conservative management. Three patients developed strictures following removal of the bands, requiring repeated sessions of dilation therapy. We report on a patient who developed absolute dysphagia and complete esophageal obstruction after variceal banding. We successfully used the endoloop cutter hook to release the bands intact and restore luminal integrity.

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References

  1. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007;46:922-938. https://doi.org/10.1002/hep.21907
  2. Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol 2003;38:266-272.
  3. D'Amico G, De Franchis R. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology 2003;38:599-612.
  4. Khuroo MS, Khuroo NS, Farahat KL, Khuroo YS, Sofi AA, Dahab ST. Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding. Aliment Pharmacol Ther 2005;21:347-361. https://doi.org/10.1111/j.1365-2036.2005.02346.x
  5. Gluud LL, Krag A. Banding ligation versus beta-blockers for primary prevention in oesophageal varices in adults. Cochrane Database Syst Rev 2012:CD004544.
  6. Petrasch F, Grothaus J, Mossner J, Schiefke I, Hoffmeister A. Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis. BMC Gastroenterol 2010;10:5. https://doi.org/10.1186/1471-230X-10-5
  7. Saltzman JR, Arora S. Complications of esophageal variceal band ligation. Gastrointest Endosc 1993;39:185-186. https://doi.org/10.1016/S0016-5107(93)70065-6
  8. Elizondo-Rivera RL, Gonzalez-Gonzalez JA, Garcia-Compean D, Maldonado-Garza HJ. Complete esophageal obstruction after endoscopic variceal band ligation. Endoscopy 2014;46 Suppl 1 UCTN:E457-E458. https://doi.org/10.1055/s-0034-1377528
  9. Nawaz A, Sarwar S, Batul A. Complete esophageal occlusion following esophageal variceal band ligation: an unusual complication: a case report. Visible Human Journal of Endoscopy 2010;9:1-4.
  10. de Melo SW. Complete esophageal occlusion after band ligation. Endoscopy 2011;43 Suppl 2 UCTN:E259. https://doi.org/10.1055/s-0030-1256522
  11. Kwiatt JT, Merchant P. Successful removal of an esophageal band causing complete esophageal obstruction after variceal ligation. Gastrointest Endosc 2016;83:1030-1031. https://doi.org/10.1016/j.gie.2015.11.035
  12. Chahal H, Ahmed A, Sexton C, Bhatia A. Complete esophageal obstruction following endoscopic variceal band ligation. J Community Hosp Intern Med Perspect 2013;3.
  13. Verma D, Pham C, Madan A. Complete esophageal obstruction: an ususual complication of esophageal variceal ligation. Endoscopy 2009;41 Suppl 2:E200-E201. https://doi.org/10.1055/s-0029-1214856
  14. Nikoloff MA, Riley TR 3rd, Schreibman IR. Complete esophageal obstruction following endoscopic variceal ligation. Gastroenterol Hepatol (N Y) 2011;7:557-559.
  15. Maric L, Alonso Y, Alvarez A, Erim T. Endoscopic variceal band ligation leading to acute onset dysphagia. Am J Gastroenterol 2016;111:S692.
  16. Mansour M, Abdel-Aziz Y, Awadh H, Shah N, Ajmera A. Complete esophageal obstruction after endoscopic variceal band ligation in a patient with a sliding hiatal hernia. ACG Case Rep J 2017;4:e8.
  17. Goff JS, Reveille RM, Van Stiegmann G. Endoscopic sclerotherapy versus endoscopic variceal ligation: esophageal symptoms, complications, and motility. Am J Gastroenterol 1988;83:1240-1244.