Predictors and management of post-banding ulcer bleeding in cirrhosis: A systematic review and meta-analysis

Background and AimsPost-banding ulcer bleeding (PBUB) is an understudied complication of oesophageal varices endoscopic band ligation (EBL). This systematic review with meta-analysis aimed at: (a) evaluating the incidence of PBUB in patients with cirrhosis treated with EBL in primary or secondary prophylaxis or urgent treatment for acute variceal bleeding and (b) identifying predictors of PBUB. MethodsWe conducted a systematic review of articles in English published in 2006-2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Searches were made in eight databases including Embase, PubMed and Cochrane Library. Random-effects meta-analysis was used to determine the incidence, mean interval and predictors of PBUB. ResultsEighteen studies (9034 patients) were included. The incidence of PBUB was 5.5% (95% CI 4.3-7.1). The mean time for it to occur was 11 days (95% CI 9.94-11.97). Model for End-stage Liver Disease (MELD) score (OR 1.162, 95% CI 1.047-1.291) and EBL done in emergency setting (OR 4.902, 95% CI 2.99-8.05) independently predicted post-ligation ulcer bleeding. Treatment included drugs, endoscopic procedures and transjugular intrahepatic portosystemic shunt. Refractory bleeding was treated with self-expandable metallic stents or balloon tamponade. Mortality was on average 22.3% (95% CI 14.1-33.6). ConclusionsPatients with high MELD score and receiving EBL in an emergency setting are more prone to develop PBUB. Prognosis is still poor and the best therapeutic strategy to address remains to be ascertained.

Automated summary

This study aimed to evaluate the incidence of post-banding ulcer bleeding (PBUB) in patients with cirrhosis treated with esophageal varices endoscopic band ligation (EBL) and identify predictors of PBUB. The results showed that the incidence of PBUB was 5.5% and the mean time for it to occur was 11 days. A high Model for End-stage Liver Disease (MELD) score and emergency EBL were identified as independent predictors of post-ligation ulcer bleeding. The treatment options included drugs, endoscopic procedures, and transjugular intrahepatic portosystemic shunt.