Post‐Banding Ulcer Bleeding After Endoscopic Ligation: Incidence, Risk Factors and Outcomes in Patients With Cirrhosis

BACKGROUND AND STUDY AIM: Post-banding ulcer bleeding (PBUB) is an understudied complication of endoscopic band ligation (EBL) used in the prevention and treatment of oesophageal variceal bleeding (VB). The aim of this study is to investigate the incidence, mortality and risk factors of PBUB. METHODS: Retrospective cohort study conducted at the university hospital of Bern (Switzerland). It included patients with cirrhosis and oesophageal varices who underwent prophylactic or urgent EBL for VB between 1 January 2018 and 31 December 2022. RESULTS: In total, 206 patients with cirrhosis, who underwent 630 sessions of EBL, were included. The incidence rate of PBUB was 17.5% (95% CI, 12.7%-23.5%), considering the total number of patients, and 6.8% (95% CI, 5.0%-9.2%) considering the total of EBL procedures. Urgent EBL (SHR: 2.78, 95% CI: 1.29-6.00, p = 0.009) and elevated creatinine (SHR: 1.04, 95% CI: 1.01-1.07, p = 0.024) were independent risk factors for PBUB on multivariate analysis. PBUB required blood product transfusions in 88.1% of events (95% CI, 73.6%-95.5%) and hospitalisation at the intensive care unit in 74.4% of events, with a median hospital stay of 2 days (range: 1-34 days). In patients with PBUB, the short-term mortality during hospitalisation was 19%, and long-term mortality at 52 weeks was 64%. CONCLUSIONS: Patients with cirrhosis undergoing urgent EBL or those with elevated creatinine levels are at increased risk of PBUB. Due to the high mortality associated with PBUB, identifying high-risk patients and implementing preventive strategies is essential for improving patient outcomes.