Endoscopic band ligation of esophageal varices in patients on anticoagulation

Endoscopic band ligation is an effective technique for primary and secondary prevention of gastro-esophageal variceal bleeding (GEVB), but can also result in rebleeding from postbanding ulcers. Its use in primary and secondary prevention of GEVB in anticoagulated patients has not been systematically studied. The aim of the study was to evaluate the feasibility of band ligation in primary and secondary prevention of GEVB in anticoagulated patients. Five patients (age 60.2+/-7.3 SD years: 3 males, 2 females) with esophageal varices on anticoagulation were studied using a retrospective chart review in a tertiary hospital setting. Patients were on mandatory anticoagulation with warfarin (international normalized ratio >2), on nonselective beta-blocker therapy if tolerated and were not transvenous intrahepatic porto-systemic shunting candidates. One patient had polycythemia vera (noncirrhotic), the rest were cirrhotics Child class B/C (1 cardiogenic, 1 primary sclerosing cholangitis, 1 Budd-Chiari, and 1 cryptogenic cirrhosis). Two patients had experienced prior acute GEVB; band ligation performed during acute bleeding was not included in the study. All patients had at least grade III-IV esophageal varices on outpatient follow-up for band ligation. Three bands were placed/patient and study patients underwent 3 banding sessions on an average. None of the patients developed GEVB after band ligation. In 3 patients banding resulted in complete variceal eradication, the remaining 2 are still being followed-up for outpatient band ligation. In conclusion, this case series suggests that endoscopic band ligation can potentially be used in anticoagulated patients without alternatives for prevention of acute GEVB.