Patient Profile
Patient Name
Mr. Prakash Iyer
Age / Gender
54 Years / Male
Consultant
Dr. Vipulroy Dayanand Rathod
Hospital
Fortis Hospitals Limited, Mulund, Mumbai
Diagnosis
Decompensated Cirrhosis with Acute Variceal Bleeding
Past History
Alcoholic Liver Disease · Cirrhosis (Child-Pugh B) · Known oesophageal varices · Ascites
Patient Background
Mr. Prakash Iyer, a 54-year-old from Dadar, Mumbai, was rushed to the emergency department at Fortis Hospital Mulund after a sudden episode of massive haematemesis and melaena at home. A known case of decompensated cirrhosis with documented oesophageal varices, his condition deteriorated rapidly with hypotension and visible pallor. His family, having previously consulted multiple physicians for his liver disease, sought immediate intervention from the Best Gastroenterologist in Mumbai experienced in emergency endoscopic management. Dr. Vipulroy Rathod, Director of Gastroenterology at Fortis Mulund and South Asia’s pioneer of advanced endoscopic procedures, was called in immediately to perform emergency endoscopic band ligation.
Symptoms
Difficulty swallowing — unable to swallow liquids or solids since ingestion
Melaena — black tarry stools indicating ongoing upper GI bleeding
Hypotension — blood pressure 86/54 mmHg on arrival
Tachycardia — heart rate 118 bpm, signs of haemodynamic instability
Pallor and visible weakness — significant blood loss with reduced consciousness
Abdominal distension — pre-existing ascites contributing to discomfort
Diagnostic Method
Plain X-ray chest and neck
confirmed radio-opaque circular foreign body (coin) impacted at the level of upper oesophagus
Blood investigations
haemoglobin 6.2 g/dL · platelets 78,000 · INR 1.8 · liver function tests deranged
Resuscitation initiated
IV fluids, packed red blood cell transfusion, IV terlipressin and IV antibiotics started as per variceal bleeding protocol
Ultrasound abdomen
confirmed cirrhotic liver with moderate ascites and splenomegaly
Emergency Upper GI Endoscopy
performed within 2 hours of admission to identify and treat the bleeding source
Disease Diagnosed
Mr. Iyer was diagnosed with acute variceal haemorrhage on a background of decompensated cirrhosis. Endoscopic evaluation revealed three large oesophageal varices with one actively spurting variceal column, identified as the source of bleeding. Variceal haemorrhage carries a mortality rate of 15 to 20 percent in the first six weeks if not promptly controlled. As an endoscopist in Mumbai with extensive emergency endoscopy experience, Dr. Rathod proceeded with emergency Endoscopic Variceal Band Ligation (EVL) to achieve immediate haemostasis.
Risks if Left Untreated:
Continued haemorrhage and haemodynamic collapse
Hypovolaemic shock and multi-organ failure
15 to 20 percent first-six-week mortality from variceal bleeding
Hepatic encephalopathy from blood load
Spontaneous bacterial peritonitis on background of ascites
Treatment Plan
Dr. Vipulroy Rathod performed emergency Endoscopic Variceal Band Ligation as the first-line definitive treatment for active variceal bleeding, achieving immediate haemostasis without surgical intervention.
Why Endoscopic Band Ligation Was Chosen Over Other Options
01 - First-Line Standard of Care
Endoscopic band ligation is the internationally recommended first-line treatment for acute variceal bleeding, with proven efficacy over sclerotherapy or balloon tamponade.
02 - Immediate Haemostasis
Bands deployed directly onto bleeding varices achieve mechanical occlusion within minutes, controlling the haemorrhage in real time.
03 - No Surgical Risk
Performed entirely through the endoscope. Avoids the prohibitive surgical and anaesthetic risks of decompensated cirrhotic patients with coagulopathy.
04 - Reduces Rebleed Rate
Significantly lowers rebleeding risk compared to medical management alone, with structured follow-up sessions for variceal eradication.
How the Procedure Was Performed
- Patient preparation — patient placed in left lateral position, IV access secured, oxygen saturation monitored continuously, anaesthesia support on standby.
- Diagnostic upper GI endoscopy — endoscope passed through the mouth to examine oesophagus, stomach, and duodenum. Three large oesophageal varices identified, one actively bleeding.
- Multi-band ligator deployment — multi-band ligator device mounted on the endoscope tip, suction applied to draw the variceal column into the cap.
- Band ligation — six elastic bands deployed sequentially onto the largest varices including the actively bleeding column. Immediate cessation of bleeding observed.
Post-ligation inspection — stomach and duodenum re-examined to rule out additional bleeding sources. No other active bleeding identified.
Procedure Summary
- Procedure: Emergency Endoscopic Variceal Band Ligation (EVL)
- Bands Deployed: 6 bands across three large oesophageal varices
- Duration: 40 minutes
- Sedation: Conscious sedation with anaesthesia standby
- Outcome: Immediate haemostasis achieved
- Post-procedure: Shifted to ICU for observation
“Variceal bleeding in a decompensated cirrhotic is one of the most time-critical emergencies in gastroenterology. Mr. Iyer arrived in shock with active bleeding. Endoscopic band ligation gave us immediate control over the bleeding column without exposing him to the risk of surgery his liver simply could not survive. Within minutes the bleeding had stopped, and within 48 hours he was haemodynamically stable. This is exactly where emergency endoscopy saves lives that medical management alone cannot.“ Dr. Vipulroy Rathod, FASGE | Gastroenterologist in Mumbai | Director, Gastroenterology and Hepatobiliary Sciences, Fortis Hospital Mulund
Post-Procedure Guidelines
Strict nil by mouth for 12 hours, then liquid diet advanced gradually as tolerated
Continued IV terlipressin and IV antibiotics for 5 days as per protocol
Beta-blocker therapy initiated for long-term variceal pressure control
Hepatology referral for liver transplant evaluation given decompensated status
Outcome
| Timepoint | Result |
|---|---|
| During Procedure | Immediate haemostasis achieved with 6-band ligation |
| 24 Hours | Haemodynamically stable, no further haematemesis or melaena |
| 48 Hours | Shifted out of ICU to ward, oral feeds resumed |
| Day 5 | IV terlipressin and antibiotics completed, oral medications continued |
| Day 7 | Discharged on beta-blocker therapy with structured follow-up plan |
| 4 Weeks | Repeat banding session completed, two additional varices ligated |
| 3 Months | No rebleeding episodes, variceal eradication progressing |
Long-Term Expectations
With successful emergency control and structured banding follow-up, Mr. Iyer’s immediate variceal bleeding risk has been substantially reduced. Long-term outcome depends on strict alcohol abstinence, beta-blocker compliance, ongoing variceal surveillance, and management of his underlying decompensated cirrhosis. Liver transplant evaluation is being progressed in parallel given his Child-Pugh status
Patient Feedback
“I do not remember much of that day. I only remember vomiting blood at home and my wife screaming for help. The next thing I knew, I was awake at Fortis Mulund and Dr. Rathod was telling me the bleeding had been stopped. He saved my life that morning. I am giving up alcohol completely and following every instruction he has given me. I owe him everything.” Prakash Iyer, 54 | Dadar, Mumbai
“I thought we had lost him in the ambulance. The team at Fortis Mulund was ready when we arrived, and Dr. Rathod did not waste a single minute. Within hours my husband was stable. We are forever grateful.” Mrs. Lakshmi Iyer, Patient’s Wife | Dadar, Mumbai