An unusual complication after variceal band ligation: complete esophageal obstruction, a case report and review of the literature

Abstract

Introduction and objectives: Endoscopic ligation is the standard therapy for secondary prophylaxis of variceal bleeding, being a simple procedure, although not without complications. A case of a rare complication is presented. Clinical case summary: 73-year-old woman with cirrhosis and a history of variceal bleeding in secondary prophylaxis. Endoscopy was performed, presenting large esophageal varices with high-risk bleeding stigmas data with ligation of 2 varices. Twenty-four hours later, he started with chest pain and progressive dysphagia to liquids and solids. Tomography showed esophageal dilatation with air-fluid level and distal narrowing. She was admitted for hospital surveillance with no response to symptomatic management and no tolerance to oral administration; an endoscopy was performed 72 hours later, observing complete obstruction of the esophagus lumen due to the tissue surrounding varix with edema and necrosis that prevented the passage of the endoscope. Conservative management was decided, with strict fasting and central parenteral nutrition for three days, with complete resolution of symptoms and tolerance to oral administration on day 5. At 12 weeks later, she reported dysphagia; the control endoscopy showed concentric stenosis in the previous ligation site, requiring dilation with a pneumatic balloon to 13 mm. Figure 1. Discussion: Among the complications after endoscopic band ligation of esophageal varices, the presentation of complete obstruction is the least frequent, finding only 14 cases reported in the literature. Conservative management and monitoring for the development of posterior stenosis are recommended. Conclusions: Physicians should be aware of all the probable subsequent complications derived from this procedure. Funding: The resources used in this study were from the hospital without any additional financing Declaration of interest: The authors declare no potential conflicts of interest.