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

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.

Figure 1. a) Chest CT (coronal) with dilation of the esophagus and an air-fluid level b) Sagittal chest CT, with stenosis in the distal third, c and d) post-ligation endoscopy with a varicose band that obstructs the esophageal lumen, edema and necrosis e) follow-up endoscopy with stenosis due to fibrosis f) post-dilation