ENDOSCOPIC FINDINGS AND OVERTUBE-RELATED COMPLICATIONS ASSOCIATED WITH ESOPHAGEAL VARICEAL LIGATION

Esophageal variceal ligation (EVL) has emerged as a popular alternativ e to endoscopic sclerotherapy (ES), with equal efficacy as ES in contr ol of active bleeding, rebleeding rate, and variceal eradication. The complication rate for EVL has been reported lower than for ES in sever al clinical trials. However, several unique complications inherent to EVL have been recognized. Overtube injury to the pharynx and proximal esophagus has been the most serious complication. Transient vocal cord paralysis, cricopharyngeal perforation, proximal esophageal laceratio n, varix rupture, and free esophageal perforation have also been repor ted. Direct banding-induced complications have been limited to rebleed ing from banded ulcers, transient esophageal obstruction, and simple s trictures. Pulmonary as well as serious systemic complications have ye t to be reported. We report four complications of EVL, review the lite rature, and suggest strategies for the recognition, management, and pr evention of EVL complications.