Severe bleeding following endoscopic variceal ligation: should EVL be avoided in Child C patients?

In the last decade there has been an evolution in the treatment of bleeding oesophageal varices. Endoscopic variceal ligation (EVL) is one of those new techniques that not only has shown to be more effective than sclerotherapy, but also causes less side effects, resulting in less episodes of rebleeding and improving survival. We describe severe bleeding in 3 patients after EVL, occurring between 5 and 10 days after the initial ligation. Two Child C patients could not be resuscitated and died shortly after this event. Severely impaired clotting function as a result of the liver disease and the greater size of the ulcers induced by EVL may contribute to this dramatic complication. Severe bleeding due to postligation ulceration may lead to death, which occurred in 2 of our Child C patients. Since more and more endoscopists are using EVL in the treatment of oesophageal variceal bleeding, they should be aware of the possible complications caused by this rather new technique.