A targeted endoscopic band ligation technique for management of acute esophageal variceal bleeding

Endoscopic band ligation (EBL) standard therapy is traditionally performed with banding from the distal esophagus upwards. However, esophageal varices (EV) with stigma of recent bleeding are not consistently banded at the first attempt. We aimed to compare conventional banding in acute variceal bleeding (AVB) vs targeted banding of EV in patients with stigma of recent bleeding (white nipple sign).

This case-control study included patients treated in our hospital from December 2016 to September 2019 with endoscopic signs of recent variceal bleeding. The targeted technique involves deploying the first band at the recent bleeding stigmata and then completing the procedure with standard variceal banding technique. The conventional group included patients treated with standard EBL.

We analyzed 92 patients, 54 (58.7%) in conventional technique and 38 (41.3%) in the targeted group. Active bleeding during endoscopy occurred in 11 (20.0%) of conventional and two (6.5%) of the targeted group (p=0.021). Although procedure time was longer in the conventional group (24.3min SD 11.58) compared to the targeted group (21.52min SD 8.73) this difference was not significant. One detached band episode was documented in targeted group and none in the conventional group (p=0.418). TIPS were not used during this study due to health system policy. There were no significant differences in mortality, rebleeding or transfusion requirements between groups.

The targeted technique for EV with stigma of recent bleeding had a low band detachment incidence and fewer bleeding events during endoscopy, however, the limitations of the study should be considered.