A prospective comparison study of the endoscopic spectrum of overtube-induced esophageal mucosal damage after esophageal band ligation (EBL)

EBL is being increasingly performed for the treatment of esophageal varices Except for perforation, the magnitude of the mucosal injury induced by the overtube (OT) used, is unknown Objective: To estimate the frequency, risk factors and severity of mucosal damage induced by two currently available types of overtubes Material and Methods: Patients undergoing EBL were prospectively studied Two types of OTs: 60F, 25cm=old OT and 60F, 20cm=new OT, were used Before OT placement, by using the 44 F bougie technique, a video and still photographs were taken at 25cm and 20-22cm from the incisors. At the end of each EBL session, the OT was withdrawn and video and still photographs were taken from the same initial locations. An injury grading system was used (0=no lesions; I=isolated,subepithelial, petechial-like lesions; II=confluent subepithehal lesions; 111= erosions; IV= hematoma and V= tear) The total time he OT was in place, presence of coagulopathy, emergent versus elective setting, development of dysphagia, odinophagia or chest pain, and the development of leukocytosis. fever or bacteremia after the EBL session, were all recorded. Results: 22 patients underwent a total of 36 RBL sessions. OT Grade 0 Grade I Grade II Grade III Grade IV Grade V New 3 1 4 6 3 1 Old 6 2 2 3 2 3 Twenty-seven sessions (75%) were associated with mucosal injury and occurred at the edge of the OT. The mean injury score for the entire group was 2.27±0.3 (R: 0-5). A mean of 6.6±0.5 bands per session (R: 2-14) were placed and the OT was in place for a mean of 12.6±1.25 min. (R: 3-32) There was no difference between the OTs, nor in the setting (acute bleeding:11 vs. elective: 26 sessions). The mean INR was 1.47±0.07 (R:0.9-2.3) but not different between the groups. One patient complained of dysphagia, odynophagia and chest pain but did not have any mucosal damage. Conclusions: 1) OT-induced esophageal injury occurred in 75% of sessions, but this was not clinically significant. 2) Injury was independent of the type of OT used or whether the session was performed for acute bleeding. 3) The presence of coagulopathy and duration of the banding procedure were not associated with more severe damage.