What is the recommended interval for repeating an Esophagogastroduodenoscopy (EGD) after esophageal banding?

From the Guidelines

Repeat endoscopy (EGD) after esophageal variceal banding should be performed approximately 1-2 weeks after the initial procedure, as recommended by the most recent and highest quality study 1. This follow-up schedule allows for assessment of band-induced ulcer healing and evaluation of any residual or recurrent varices that may require additional banding. The timing is crucial because band-induced ulcers typically heal within 2-3 weeks, and premature endoscopy may reveal unhealed ulcers that could be misinterpreted as requiring intervention. Some key points to consider when deciding on the follow-up schedule include:

• The patient's underlying liver disease severity and clinical status
• The presence of any residual or recurrent varices
• The risk of rebleeding, which can be reduced with beta-blocker therapy After the initial follow-up, if varices are still present but reduced in size, subsequent sessions should be scheduled every 1-2 weeks until complete eradication is achieved, as suggested by 1 and 1. Once varices are eradicated, surveillance endoscopies are recommended at 3-6 month intervals for the first year, then every 6-12 months thereafter, depending on the patient's underlying liver disease severity and clinical status, as recommended by 1. This surveillance schedule is important because recurrence of esophageal varices is common, occurring in approximately 30-70% of patients within one year after successful eradication. Patients should continue their beta-blocker therapy even after successful banding, as this reduces portal pressure and decreases the risk of rebleeding. It is also worth noting that proton pump inhibitors may be beneficial in reducing the size of post-EVL ulcers and the risk of post-EVL bleeding, as suggested by 1.

From the Research

Repeating EGD after Esophageal Banding

• The European Society of Gastrointestinal Endoscopy (ESGE) recommends that patients who have undergone endoscopic band ligation (EBL) for acute esophageal variceal hemorrhage should be scheduled for follow-up EBLs at 1- to 4-weekly intervals to eradicate esophageal varices 2.
• After variceal eradication is achieved, surveillance EGD should be performed every 3-6 months in the first year following eradication 2.
• Another study suggests that variceal eradication is best accomplished with repeat band ligation every 10 to 14 days until varices are obliterated 3.
• The frequency of repeating EGD after esophageal banding may vary depending on the patient's condition and the presence of risk factors for post-banding ulcer bleeding, such as hepatocellular carcinoma, poor liver function, and a low beta-blocker dose 4.

Risk Factors and Prognosis

• Post-banding ulcer bleeding is a rare complication of endoscopic band ligation of esophageal varices with high morbidity and mortality 4.
• Independent risk factors for post-banding ulcer bleeding include MELD score, hepatocellular carcinoma, and total beta-blocker dose 4.
• Active bleeding or adherent clots at the time of endoscopy is associated with treatment failure or death 4.

Management and Treatment

• Endoscopic band ligation is the endoscopic prophylactic treatment of choice for patients with high-risk esophageal varices who are unable to receive nonselective beta blocker therapy 2.
• Vasoactive agents, such as terlipressin, octreotide, or somatostatin, should be initiated at the time of presentation in patients with suspected acute variceal bleeding and continued for a duration of up to 5 days 2.
• Antibiotic prophylaxis using ceftriaxone 1g/day for up to 7 days is recommended for all patients with acute variceal hemorrhage 2.