Complete esophageal obstruction after endoscopic variceal band ligation.

Endoscopic variceal band ligation (EVL) is the endoscopic therapy of choice for esophageal varices. We present a very rare complication of EVL: complete esophageal obstruction [1]. A 64-year-old woman with cirrhosis was admitted for her fourth EVL. During the procedure, esophageal mucosal scarring from previous ligation, mild stenosis of the lower third of the esophagus, and a single large varix were identified. The large varix was ligated with only one band (Cook Medical, Bloomington, Indiana, USA). The banded varix almost occluded the esophageal lumen (●" Fig.1, ●" Video 1). The patient was sent home asymptomatic. Dysphagia, vomiting, and chest paindeveloped, and she returned to our emergency department appearing ill. The physical examination findingswerenormal. AGastrografin swallow showed esophageal dilatation with complete obstruction at the distal esophagus (●" Fig.2). During upper gastrointestinal endoscopy, black mucosa and a complete esophageal obstruction were found at the site of the previous banding (●" Fig.3,●" Video 2). The patient was given nothing by mouth for 7 days, afterwhichshewas able to toleratea liquid diet. By day 11, she could tolerate a full diet. At4months afterEVL, she is asymptomatic. Complete esophageal obstruction is a very rare event. To our knowledge, only three other cases have been reported in the literature. Verma et al. [2] and Nikoloff et al. [3] separately reported patients with complete esophageal obstruction after a second EVL procedure. Both patients completely recovered with only supportive therapy. Chahal et al. [4] reported a similar patient; however, they tried unsuccessfully to reopen the esophagus with a biopsy forceps, and esophageal dissection occurred. The patient completely recovered without further intervention. Several factors andmechanisms can be involved in the development of an esophageal obstruction, such as a large size of the varix, the excessive use of suction, mucosal scarring due to previous ligation procedures, and esophageal stenosis. It is suggested that this complication may be prevented with a correct banding technique and careful suctioning of the esophageal varix. Most of the time, only supportive therapy is needed. Endoscopy_UCTN_Code_CPL_1AH_2AJ