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Rare cause of dysphagia after esophageal variceal banding: A case report

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 e...

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Autores principales: Sobotka, Lindsay A, Ramsey, Mitchell L, Wellner, Michael, Kelly, Sean G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475704/
https://www.ncbi.nlm.nih.gov/pubmed/31040890
http://dx.doi.org/10.4253/wjge.v11.i4.292
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author Sobotka, Lindsay A
Ramsey, Mitchell L
Wellner, Michael
Kelly, Sean G
author_facet Sobotka, Lindsay A
Ramsey, Mitchell L
Wellner, Michael
Kelly, Sean G
author_sort Sobotka, Lindsay A
collection PubMed
description 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.
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spelling pubmed-64757042019-04-30 Rare cause of dysphagia after esophageal variceal banding: A case report Sobotka, Lindsay A Ramsey, Mitchell L Wellner, Michael Kelly, Sean G World J Gastrointest Endosc Case Report 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. Baishideng Publishing Group Inc 2019-04-16 2019-04-16 /pmc/articles/PMC6475704/ /pubmed/31040890 http://dx.doi.org/10.4253/wjge.v11.i4.292 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ 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.
spellingShingle Case Report
Sobotka, Lindsay A
Ramsey, Mitchell L
Wellner, Michael
Kelly, Sean G
Rare cause of dysphagia after esophageal variceal banding: A case report
title Rare cause of dysphagia after esophageal variceal banding: A case report
title_full Rare cause of dysphagia after esophageal variceal banding: A case report
title_fullStr Rare cause of dysphagia after esophageal variceal banding: A case report
title_full_unstemmed Rare cause of dysphagia after esophageal variceal banding: A case report
title_short Rare cause of dysphagia after esophageal variceal banding: A case report
title_sort rare cause of dysphagia after esophageal variceal banding: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475704/
https://www.ncbi.nlm.nih.gov/pubmed/31040890
http://dx.doi.org/10.4253/wjge.v11.i4.292
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