Minimal and Maximal Extent of Band Ligation for Acute Variceal Bleeding during the First Endoscopic Session

Abstract

Background/Aims The appropriate number of band ligations during the first endoscopic session for acute variceal bleeding is debatable. We aimed to compare the technical aspects of endoscopic variceal ligation (EVL) in patients with variceal bleeding according to the number of bands placed per session. Methods We retrospectively reviewed multicenter data from patients who underwent EVL for acute variceal bleeding. Patients were classified into minimal EVL (targeting only the foci with active bleeding or stigmata of recent bleeding) and maximal EVL (targeting potential bleeding sources in addition to the aforementioned targets) groups. The primary endpoint was 5-day treatment failure. The secondary endpoints were 30-day rebleeding, 30-day mortality, and intraprocedural adverse events. Results Minimal EVL was associated with lower rates of hypoxia and shock during EVL than maximal EVL (hypoxia, 0.9% vs 2.9%; shock, 1.3% vs 3.4%). However, treatment failure was higher in the minimal EVL group than in the maximal EVL group (odds ratio, 1.60; 95% confidence interval, 1.06 to 2.41). Age ≥60 years, Model for End-Stage Liver Disease score ≥15, Child-Turcotte-Pugh classification C, presence of hepatocellular carcinoma, and systolic blood pressure <90 mm Hg at initial presentation were also associated with treatment failure. In contrast, 30-day rebleeding and 30-day mortality did not differ between the minimal and maximal EVL groups. Conclusions Given that minimal EVL was associated with a high risk of treatment failure, maximal EVL may be a better option for variceal bleeding. However, the minimal EVL strategy should be considered in select patients because it does not affect 30-day rebleeding and mortality.

Validation of PH and Varices Risk Scores for Prediction of High-Risk Esophageal Varix and Bleeding in Patients with B-Viral Cirrhosis

“…Portal hypertension (PH) is a progressive complication of liver cirrhosis, leading to portosystemic collaterals, such as esophageal varices (EVs) [ 1 , 2 ]. Moreover, EV bleeding (EVB) is one of the most life-threatening complications, and it can accelerate the progression of hepatic decompensation to a stage wherein patients have an extremely high risk of death [ 3 , 4 ]. Therefore, the current guidelines recommend screening all patients with cirrhosis by endoscopy to identify those with high-risk EVs (HEVs), so that prophylactic treatment may be considered [ 5 , 6 , 7 ].…”

Treatment of Symptomatic Hemorrhoids by Baron’s Band Ligation

“…Although conventional hemorrhoidectomy is known as minor surgical trauma, it is associated with varying degrees of postoperative pain, and the patient heals the open wound after hemorrhoidectomy. Haemorrhoidal artery ligation (HAL) and staple hemorrhoidectomy versus open hemorrhoidectomy, have a faster recovery and low complication rate, but a higher concern is cost effectiveness and availability issues, so these transactions are not done as often as RBL [9][10] . Rubber ligation is known to be an effective and ideal treatment for second-degree haemorrhoids.…”