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Background and aims: Endoscopic variceal band ligation (EVBL) plays an important role in management of esophageal varices for both primary prophylaxis and acute hemorrhage. However, life-threatening bleeding secondary to postbanding ulceration, whilst uncommon, can occur. This study aimed to identify rates of EVBL-induced ulcer bleeding in elective and non-elective settings, and to assess potential risk factors which contribute to this serious complication. Method: This was a retrospective cross-sectional analysis of cirrhotic patients who underwent EVBL over a four-year period in a tertiary hospital in Australia. Differences between the bleeding group and controls were assessed using univariate analysis. Results: 336 episodes of EVBL were identified with 19 episodes (5.6%) resulting in EVBL-induced ulcer bleeding. The mean time to re-bleeding occurred within 11 days (+/-1.36) of ligation. The incidence of EVBL-induced ulcer bleeding was 8.5% (N = 11) in the emergent setting compared to 4.0% (N = 8) in the elective setting. Factors found to significantly affect the rate of EVBL-induced ulcer bleeding included previous history of variceal bleeding (OR 2.91, p = 0.0333), presence of high-risk stigmata on endoscopy (OR 7.83, p = 0.016) and lower hemoglobin at time of initial endoscopy (mean 88.58 vs. 107.5, p = 0.0012). Unlike previous studies, proton pump inhibitor (PPI) use was not protective in reducing the risk of post EVBL-ulcer bleeding (OR 1.39, p = 0.62). Conclusion: Strategies to address these risk factors should be adopted prior to endoscopic band ligation to minimise the risk of EVBL-ulcer bleeding. Consideration should also be given to investigating whether PPI use among this high-risk group confers any benefit.

Identification of High-Risk Individuals for Bleeding from Post-Endoscopic Variceal Band Ligation Ulceration