Risk of ulcer bleeding after band ligation tied to stigmata presence, number of varices

A recent study reports an 8.5-percent overall incidence of ulcer bleeding after band ligation (BL) for the treatment of esophageal varices.

The increased risk of post-BL bleeding is associated with the presence of high-risk stigmata, higher number of varices, and bands per variceal site. In addition, no statistically significant effect of proton pump inhibitors is observed.

Records of patients with esophageal varices who underwent endoscopic haemostasis by BL at the Xiangya Hospital of Central South University in Changsha, China, between 2015 and 2020, were retrospectively reviewed. The authors statistically compared patients with post-BL ulcer bleeding and those without (controls).

The development of BL-induced ulcer bleeding was the outcome variable, while independent variables included the patients’ demographics, clinical, and laboratory parameters. Finally, the authors performed both univariate and multivariate analyses to identify possible related factors.

A total of 4,579 patients met the eligibility criteria, of which 388 (8.5 percent) presented with post-BL ulcer bleeding.

The risk of bleeding was 1.271 times higher (95 percent confidence interval [CI], 1.018‒1.587) in the presence of high-risk stigmata. A greater number of varices also contributed to an elevated risk of post-BL ulcer bleeding (odds ratio [OR], 1.184, 95 percent CI, 1.073‒1.307). Conversely, the use of fewer bands per variceal site resulted in fewer bleeding incidence (OR, 1.308, 95 percent CI, 1.090‒1.569).

In univariate analysis, proton pump inhibitor was found to confer protective benefits (OR, 0.770, 95 percent CI, 0.603‒0.983), but this effect was not significant in multivariate analysis (OR, 1.283, 95 percent CI, 1.003‒1.640).

“BL plays a vital role in treating esophageal varices; however, the procedure carries a considerable risk of band slippage, variceal site ulcer formation, and post-treatment bleeding,” the authors said.