Predictive factors of bleeding related to post-banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case-control study

Aliment Pharmacol Ther. 2010 Jul;32(2):225-32. doi: 10.1111/j.1365-2036.2010.04331.x. Epub 2010 Apr 16.


Background: Life-threatening bleeding caused by early spontaneous slippage of rubber bands has been described after variceal ligation in cirrhotic patients.

Aim: 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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Loss, Surgical
  • Case-Control Studies
  • Endoscopy, Gastrointestinal*
  • Esophageal and Gastric Varices / surgery*
  • Female
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / surgery*
  • Humans
  • Ligation
  • Liver Cirrhosis / complications*
  • Male
  • Middle Aged
  • Stomach Ulcer / complications*
  • Treatment Outcome