2025 Clinician Corner - When banding goes bad: Two rare complications of endoscopic variceal banding ligation

Overview

Abstract 

Endoscopic variceal band ligation (EVBL) is a key therapy for the management of esophageal varices in patients with cirrhosis, but complications, though infrequent, can have significant clinical implications. We report a rare case of a 76-year-old woman with metabolic-associated steatotic liver disease cirrhosis who developed esophageal obstruction followed by a severe esophageal stricture after EVBL. Initial symptoms included dysphagia and chest pain, which led to the discovery of complete esophageal obstruction secondary to sloughing mucosa and detached bands on endoscopy. After endoscopic removal of the obstructing material, the patient initially had improvement in symptoms, but these symptoms recurred with repeat endoscopy, demonstrating a severe esophageal stricture requiring serial dilations. This case underscores the importance of vigilance in recognizing and managing two rare complications of EVBL, esophageal obstruction and stricture development, to improve patient outcomes.    

Keywords:  Dysphagia, esophageal band ligation, esophageal stricture, esophageal varices  

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on July 1, 2026.

Learning Objectives

After completing the article, the learner should be able to:

  • Recognize complications that can occur following endoscopic variceal band ligation (EVBL), including the clinical presentation and diagnostic findings of esophageal obstruction after EVBL. 
  • Identify the mechanisms underlying esophageal stricture formation such as mucosal necrosis and subsequent fibrosis after EVBL. 
  • Identify the potential causes of dysphagia following EVBL based on symptom timing and underlying anatomical abnormalities. 

Key Points 

  • Endoscopic variceal band ligation (EVBL) has emerged as the first-line treatment for the prophylactic and therapeutic management of esophageal varices due to its effectiveness in reducing the incidence of variceal hemorrhage, a potentially life-threatening complication in cirrhotic patients. 
  • Although EVBL is regarded as safe, various complications have been reported, ranging from common events such as recurrent bleeding and esophageal ulceration to rarer, yet more severe events, such as esophageal obstruction and stricture formation. 
  • It is crucial to identify these complications promptly to provide appropriate management and to improve patient outcomes.
Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
07/01/2025
Course expires: 
07/01/2026
Cost:
$25.00
Rating: 
0

Faculty

  • Ambreen A. Merchant, MD - Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA 
  • Samantha Zaro, MD - Division of Gastroenterology, Baylor University Medical Center, Dallas, Texas, USA 
  • Anh D. Nguyen, MD - Division of Gastroenterology, Baylor University Medical Center, Dallas, Texas, USA and Baylor Scott & White Center for Esophageal Diseases, Baylor University Medical Center, Dallas, Texas, USA 

Corresponding author: Ambreen A. Merchant, MD, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246 (e-mail: ambreen.merchant@bswhealth.org

Accreditation

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

 

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

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Price

Cost:
$25.00
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