Published online Apr 16, 2019. doi: 10.4253/wjge.v11.i4.292
Peer-review started: January 31, 2019
First decision: March 11, 2019
Revised: March 14, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: April 16, 2019
Processing time: 78 Days and 11.1 Hours
Esophageal varices are a result of progressive liver disease and portal hypertension. Treatment can be performed with band ligation versus non-selective beta blockers depending on the size of varices, ability to tolerate medications and history of variceal bleeding. Band ligation is an effective intervention with rare but serious complications including bleeding, ulcers and rarely obstruction. Few cases of esophageal obstruction and necrosis caused by banding have been reported, each with varied management from conservative treatment to band removal.
An 89 years old woman with a past medical history of nonalcoholic steatohepatitis cirrhosis presented to the hospital with an inability to swallow one day after screening esophagogastroduodenoscopy where band ligation of esophageal varices was performed for primary prophylaxis. The patient was not able to tolerate her oral secretions. Initial blood work revealed a Model of End Organ Liver Disease score of 7. She was treated with sublingual nitroglycerin for esophageal spasm, a known complication after esophageal banding. When she failed to improve, esophagogastroduodenoscopy was performed and revealed the mucosa surrounding the banded varix was necrosed and blocking the lumen of the esophagus. The band was purposefully dislodged, revealing distal ulceration and stricturing. Within 72 h after band removal, she was tolerating an oral diet. Endoscopy performed 2 wk later revealed an intrinsic stenosis, measuring 8 mm in diameter by 1 cm in length, which was dilated.
Esophageal obstruction is a complication of variceal banding that should be considered in patients with inability to tolerate oral diet after banding.
Core tip: Complete esophageal obstruction and necrosis is a rare complication of esophageal variceal banding. Patients typically present with dysphagia and inability to tolerate secretions shortly after banding. Diagnosis is made with a barium esophagram or upper endoscopy. Treatment consists of supportive care and total parental nutrition until recovery or removing the band endoscopically. Most patients recover but may require esophageal dilation afterwards.