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 ne w techniques that not only has shown to be more effective than sclerotherap y, but also causes less side effects, resulting in less episodes of rebleed ing and improving survival. We describe severe bleeding in 3 patients after EVL, occurring between 5 an d 10 days after the initial ligation. Two Child C patients could not be res uscitated and died shortly after this event. Severely impaired clotting fun ction as a result of the liver disease and the greater size of the ulcers i nduced by EVL mag. contribute to this dramatic complication. Severe bleeding due to postligation ulceration mag lead to death, which occ urred in 2 of our Child C patients, Since more and more endoscopists are us ing EVL in the treatment of oesophageal variceal bleeding, they should be a ware of the possible complications caused by this rather new technique.