Rates of Recurrent Variceal Bleeding Are Low with Modern Esophageal Banding Strategies: A Retrospective Cohort Study

Abstract

Background: Variceal bleeding has a high rate of mortality and recurrence. Endoscopic band ligation (EBL) is the established standard of care for secondary prevention of variceal bleeding. Objective: To determine the long-term re-bleeding rate of an EBL protocol similar to current society guidelines. Design: We conducted a retrospective cohort study at a tertiary care center of all patients with a history of a variceal bleed who underwent an aggressive band ligation protocol. Interventions: At the time of sentinel bleed, all varices, regardless of size, were ligated. EBL was then repeated every 2 weeks until stabilization, and all visible varices were ligated. The interval between banding sessions then increased. Main Outcome Measurements: The incidence of re-bleeding was calculated as the time between clinical stabilization after the sentinel event until data censoring, which occurred at time of re-bleed, death, transplant, or loss-to-follow up. Gastric variceal bleeding was a secondary endpoint. Results: N=176 patients were treated with aggressive EBL, and followed for a median of 16 months (range, 3 months – 6.9 years). The 6 month incidence of re-bleeding was 2.3%, the 12 month incidence was 3.4%, and the 2 year incidence was 4.6%. Overall, aggressive EBL was well-tolerated. One patient died during follow up secondary to a gastric variceal bleed. Conclusions: Aggressive EBL yields a low rate of re-bleeding when compared to standard practice. Secondary prophylaxis with aggressive EBL should be a consideration for patients following a sentinel bleeding event.