Efficacy and Safety of Endoscopic Band Ligation in the Treatment of Actively Bleeding Portal Hypertensive Gastropathy in Cirrhosis

Abstract

Background: Portal hypertensive gastropathy (PHG) is a common complication of cirrhosis, which is often underestimated in clinical practice. PHG most often lead to chronic GI blood loss manifested as transfusion dependant anaemia, however, it may also presents with acute and even massive GI bleeding.At present, there is no clear recommendations regarding the best treatment of acute bleeding from PHG, and effective management of this condition remains a clinical challenge. Herein, we report our experience in the control of acute bleeding from PHG by targeted endoscopic band ligation (EBL) Methods: In the period from January the 1st 2021 to January the 1st 2022, a total of 30 cirrhotic patients with actively bleeding PHG were selected and identified from 800 cirrhotic patients who underwent emergency UGI endoscopy for acute UGI bleeding in our endoscopy center during this period. They were treated by targeted EBL that was applied only for the bleeding PHG lesions. All treated patients were placed on NSBBs (propranolol) in incremental doses, proton pump inhibitors and antibiotics with close monitoring. A follow-up endoscopy was performed for all patients one week after the initial hemostatic procedure. Results: Initial hemostasis was achieved in all treated patients (100%) while recurrent bleeding was observed only in 3(10%) patients. No serious complication was observed in any of the treated patients. Conclusion: Based on the results of the present study, one may say that targeted EBL is an effective, simple, cheap and safe hemostatic
modality for the control of acute bleeding from PHG that should be among the first line options in the endoscopic treatment of this elusive and difficult to treat bleeding PHG.