ArticleBMC gastroenterology2026
Endoscopic variceal ligation-induced ulcer bleeding: incidence by indication, real-world treatment, and outcomes.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeEndoscopic variceal ligation (EVL) - induced ulcer bleeding is a rare but potentially life-threatening complication. While the incidence following elective and emergency EVL has been reported, semi-elective procedures performed during hospitalization for acute decompensation of cirrhosis have not been separately examined. Additionally, real-world data on endoscopic treatment strategies, hemostasis rates and outcomes are scarce.
methodsWe conducted a retrospective cohort study analyzing all ligation procedures performed in adults with portal hypertension and esophageal varices at Charité University Hospital, Campus Virchow and Campus Mitte, from 01/01/2016 until 06/30/2023. We assessed incidence and risk factors by ligation indication, described endoscopic treatment strategies and analyzed predictors of 5-day rebleeding and 6-week mortality.
resultsAmong 1,864 EVLs, 61 (3.3%) resulted in EVL-induced ulcer bleeding; 60 were analyzed. Incidence varied significantly by indication: 0.44% after elective, 8.5% after emergency and 15.9% after semi-elective EVL. Repeat ligation was the most common endoscopic treatment (32.4%), followed by fibrin glue (14.7%) and balloon tamponade (11.7%); the overall primary hemostasis rate was 82.8%. Ten patients (16.7%) underwent TIPS. The 5-day rebleeding rate was 25% and the 6-week mortality rate 41.7%. Multivariate logistic regression analysis revealed that 5-day rebleeding (OR: 8.05; 1.66-39.2; p = 0.01) and post-bleeding sepsis (OR 7.27; 1.15-45.73; p = 0.035) were strongly associated with 6-week mortality.
conclusionsSemi-elective EVL carries 45-fold higher odds for EVL-induced ulcer bleeding. Endoscopic hemostasis is achievable, but early rebleeding and post-bleeding sepsis drive mortality, suggesting that considering early TIPS in high-risk patients and preventing sepsis deserve more attention.
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