Post-Banding Ulcer bleeding in Cirrhotic Patients: A Prospective Cohort Study

Background: Post-banding ulcer bleeding (PBUB) is an uncommon but life-threatening complication of esophageal variceal ligation (EVL). Evidence on its predictors remains inconsistent and limited, especially among cirrhotic patients undergoing routine surveillance or emergency interventions. Objective: To identify the incidence and risk factors for PBUB after EVL in patients with liver cirrhosis. Patients and Methods: This prospective cohort study was carried out on 110 cirrhotic patients undergoing prophylactic or therapeutic EVL and were followed for PBUB between June 2023 and June 2024. Baseline clinical, laboratory, ultrasonographic, and endoscopic variables were recorded. Patients developing PBUB were compared with PBUB-free patients. Results: PBUB occurred in 5 of 110 patients (4.5%). Compared with non-PBUB patients, those with PBUB more frequently had prior variceal bleeding (40% vs. 3.8%), diabetes mellitus (80% vs. 32.4%), hepatocellular carcinoma (HCC) (80% vs. 28.6%), and portal vein thrombosis (PVT) (80% vs. 24.8%). They presented with higher pulse rates (95 vs. 83 beats/min), lower hemoglobin (8.6 vs. 10.6 g/dl), elevated urea (56 vs. 28 mg/dl), and universally positive CRP. Endoscopically, PBUB patients had higher-grade varices (grade 3–4 in 80%), more variceal columns (mean 4.2 vs. 2.8), frequent peptic esophagitis (80%), and exclusively underwent emergency EVL. Mortality among PBUB cases was 60%. Significant predictors of PBUB included baseline hematemesis, peptic esophagitis, previous variceal bleeding, HCC, higher variceal grades, larger spleen size, and PVT. Conclusion: PBUB is infrequent yet associated with substantial morbidity and mortality. Several baseline clinical and endoscopic factors can help identify high-risk patients and guide preventive strategies.