Esophageal band removal

Kwiatt_headshotJames T. Kwiatt, MD, from GI Associates, LLC in Wauwatosa, Wisconsin, USA shares this video case “Successful removal of an esophageal band causing complete esophageal obstruction after variceal ligation.”

A patient was sent to our facility after having adverse events from an EGD with band ligation of esophageal varices. During the procedure the patient was coughing and gagging; this resulted in band ligation of all walls of the esophageal lumen resulting in esophageal obstruction. She decompensated and was high risk of aspiration, warranting urgent removal of the band. After attempting to remove the band with a biopsy forceps and a rat tooth forceps, we were able use a polyp loop cutter to remove the band. The “hook” shape of the bottom jaw of the loop cutter allowed for grasping of the band and successful removal. Kwiatt_fig

Figure 1. A, Complete esophageal obstruction from band. B, Use of loop cutter to grasp and remove the band. C, 4 weeks after intervention, follow-up examination shows healed mucosa and slight esophageal tapering.

While this is a rare adverse event of variceal band ligation, the loop cutter provided a resolution to the problem. Should other endoscopists encounter this situation, we felt it was important to have this knowledge in the medical literature.

Always take input from the entire endoscopy team. The nurses and techs involved in the case were instrumental in thinking of various tools and solutions to the patients problem.  The entire team gave input which help us come to the solution.

Find more VideoGIE cases online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

2 thoughts on “Esophageal band removal

  1. M Yasin

    Sir,
    Nice way to remove the band’s. I have some queries.
    1. What about leaving the band like this for a couple of days till it sloughs. Till then, put the patient on liquid diet. It’s just an opinion. Please give your feedback.
    2. Isnt it risky to try removing the band’s? The risk of bleeding and God forbid, if bleeding occurs , What’s the treatment options for us leaving aside the octrotide or terlipressin.?
    Regards

    1. 1. The patient was developing severe encephalopathy and was high risk for aspiration, hence I felt the benefit of removal outweighed the risks.
      2. Interventional radiology was available at our institution to provide back up in the event a TIPS or embolization was required.

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