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When banding fails; investigation hails
  1. F Arnold1,
  2. D Patch2,
  3. D Yu3,
  4. R H Westbrook2
  1. 1 Albertine, Haywards Heath, UK
  2. 2 Hepatology Department, Royal Free Hospital, London, UK
  3. 3 Radiology Department, Royal Free Hospital, London, UK
  1. Correspondence to Dr F Arnold, Albertine, Horsham Road, Handcross, Haywards Heath, West Sussex RH 17 6DE, UK; frances.arnold{at}

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Clinical presentation

A 67-year-old man presented to our centre 5 years ago with a short history of jaundice and weight loss. A diagnosis of autoimmune hepatitis was made following laboratory investigations, imaging and a trans-jugular liver (TJ) biopsy. He was treated with prednisolone and azathioprine, which resulted in normalisation of his transaminases and bilirubin. Four years later, he was diagnosed with cirrhosis (Childs class A) based on clinical, biochemical and radiological parameters. He underwent a screening endoscopy, which revealed grade III oesophageal varices with multiple red signs and was started on propranolol as primary prophylaxis. He was unable to tolerate β blockers and oesophageal endoscopic band ligation (EBL) was subsequently undertaken. He underwent six further upper GI endoscopies with repeated EBL of his oesophageal varices; however, the grade III varices with red signs …

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  • Contributors DP and RHW were involved in the clinical care of the patient and identifying the case as appropriate for submission. DP gained the consent of the patient and both provided critical analysis in the drafting of the final article. DY created and reported the images, having carried out the interventional radiology procedures. He selected the most appropriate images for this article and provided guidance on the text describing them. FA wrote the article and liaised with the team to take it from draft to final submission. FA is the corresponding author.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.