When banding goes bad: two rare complications of endoscopic variceal banding ligation

Endoscopic variceal band ligation (EVBL) is a key therapy for the management of esophageal varices in patients with cirrhosis, but complications, though infrequent, can have significant clinical implications. We report a rare case of a 76-year-old woman with metabolic-associated steatotic liver disease cirrhosis who developed esophageal obstruction followed by a severe esophageal stricture after EVBL. Initial symptoms included dysphagia and chest pain, which led to the discovery of complete esophageal obstruction secondary to sloughing mucosa and detached bands on endoscopy. After endoscopic removal of the obstructing material, the patient initially had improvement in symptoms, but these symptoms recurred with repeat endoscopy, demonstrating a severe esophageal stricture requiring serial dilations. This case underscores the importance of vigilance in recognizing and managing two rare complications of EVBL, esophageal obstruction and stricture development, to improve patient outcomes.