Optimal time for follow-up after variceal band ligation in patients with cirrhosis: a multi-center randomized controlled trial

Abstract Background Esophageal varices can lead to morbidity and mortality in patients with chronic liver diseases. There is a debate about the frequency of endoscopic variceal band ligation sessions needed for the eradication of esophageal varices. We aimed to explore the optimal interval for endoscopic variceal band ligation sessions needed to obliterate esophageal varices. Methods This study enrolled 374 patients with liver cirrhosis indicated for endoscopic variceal band ligation. After the first variceal band ligation, patients were randomly assigned to one of four groups regarding the interval of subsequent band ligation sessions: group 1 (subsequent band ligation every week), group 2 (subsequent band ligation every 2 weeks), group 3 (subsequent band ligation every 3 weeks), and group 4 (subsequent band ligation every 4 weeks). Patients were followed until esophageal varices were eradicated, with complications reported as bleeding or post-banding ulcers. Results The studied groups showed insignificant differences in the mean number of sessions required to eradicate varices completely and the mean number of subsequent band ligation sessions. Post-banding ulcers were highly incident in group 1 (52.9%), followed by group 2 (22.8%), group 3 (8.0%), and group 4 (2.7%), with a statistically significant difference between the studied groups ( p < 0.001). Bleeding after the first band ligation session was reported in only group 2 (1.3%). Conclusion A 4-week interval of elective variceal band ligation sessions achieved complete eradication with a lower rate of complications, particularly post-banding ulcers.