Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2019; 11(4): 292-297
Published online Apr 16, 2019. doi: 10.4253/wjge.v11.i4.292
Rare cause of dysphagia after esophageal variceal banding: A case report
Lindsay A Sobotka, Mitchell L Ramsey, Michael Wellner, Sean G Kelly
Lindsay A Sobotka, Mitchell L Ramsey, Michael Wellner, Sean G Kelly, Department of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Sobotka LA, Ramsey ML, Wellner M and Kelly SG contributed equally to this work; all authors participated in collection of information, drafting of the case series, critical review and approve of the final draft.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE checklist and the manuscript was prepared and revised according to the CARE checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sean G Kelly, MD, Doctor, Department of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH 43210, United States. sean.kelly@osumc.edu
Telephone: +1-614-2938000
Received: January 30, 2019
Peer-review started: January 31, 2019
First decision: March 11, 2019
Revised: March 14, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: April 16, 2019
Abstract
BACKGROUND

Esophageal varices are a result of progressive liver disease and portal hypertension. Treatment can be performed with band ligation versus non-selective beta blockers depending on the size of varices, ability to tolerate medications and history of variceal bleeding. Band ligation is an effective intervention with rare but serious complications including bleeding, ulcers and rarely obstruction. Few cases of esophageal obstruction and necrosis caused by banding have been reported, each with varied management from conservative treatment to band removal.

CASE SUMMARY

An 89 years old woman with a past medical history of nonalcoholic steatohepatitis cirrhosis presented to the hospital with an inability to swallow one day after screening esophagogastroduodenoscopy where band ligation of esophageal varices was performed for primary prophylaxis. The patient was not able to tolerate her oral secretions. Initial blood work revealed a Model of End Organ Liver Disease score of 7. She was treated with sublingual nitroglycerin for esophageal spasm, a known complication after esophageal banding. When she failed to improve, esophagogastroduodenoscopy was performed and revealed the mucosa surrounding the banded varix was necrosed and blocking the lumen of the esophagus. The band was purposefully dislodged, revealing distal ulceration and stricturing. Within 72 h after band removal, she was tolerating an oral diet. Endoscopy performed 2 wk later revealed an intrinsic stenosis, measuring 8 mm in diameter by 1 cm in length, which was dilated.

CONCLUSION

Esophageal obstruction is a complication of variceal banding that should be considered in patients with inability to tolerate oral diet after banding.

Keywords: Case report, Esophageal varices, Band ligation, Esophageal necrosis, Esophageal obstruction

Core tip: Complete esophageal obstruction and necrosis is a rare complication of esophageal variceal banding. Patients typically present with dysphagia and inability to tolerate secretions shortly after banding. Diagnosis is made with a barium esophagram or upper endoscopy. Treatment consists of supportive care and total parental nutrition until recovery or removing the band endoscopically. Most patients recover but may require esophageal dilation afterwards.