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While the incidence following elective and emergency EVL has been reported, semi-elective procedures performed during hospitalization for acute decompensation of cirrhosis have not been separately examined. Additionally, real-world data on endoscopic treatment strategies, hemostasis rates and outcomes are scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study analyzing all ligation procedures performed in adults with portal hypertension and esophageal varices at Charit\u00e9 University Hospital, Campus Virchow and Campus Mitte, from 01\/01\/2016 until 06\/30\/2023. We assessed incidence and risk factors by ligation indication, described endoscopic treatment strategies and analyzed predictors of 5-day rebleeding and 6-week mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1,864 EVLs, 61 (3.3%) resulted in EVL-induced ulcer bleeding; 60 were analyzed. Incidence varied significantly by indication: 0.44% after elective, 8.5% after emergency and 15.9% after semi-elective EVL. Repeat ligation was the most common endoscopic treatment (32.4%), followed by fibrin glue (14.7%) and balloon tamponade (11.7%); the overall primary hemostasis rate was 82.8%. Ten patients (16.7%) underwent TIPS. The 5-day rebleeding rate was 25% and the 6-week mortality rate 41.7%. Multivariate logistic regression analysis revealed that 5-day rebleeding (OR: 8.05; 1.66\u201339.2;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) and post-bleeding sepsis (OR 7.27; 1.15\u201345.73;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.035) were strongly associated with 6-week mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Semi-elective EVL carries 45-fold higher odds for EVL-induced ulcer bleeding. Endoscopic hemostasis is achievable, but early rebleeding and post-bleeding sepsis drive mortality, suggesting that considering early TIPS in high-risk patients and preventing sepsis deserve more attention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-026-05141-5","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T02:25:23Z","timestamp":1784859923000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Endoscopic variceal ligation-induced ulcer bleeding: incidence by indication, real-world treatment, and outcomes"],"prefix":"10.1186","volume":"26","author":[{"given":"Thomas","family":"Vasilakis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Schauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donata","family":"Grajecki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Wree","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"J\u00fcrgensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Tacke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius","family":"Engelmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"issue":"2","key":"5141_CR1","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.tgie.2017.03.005","volume":"19","author":"AF Gulamhusein","year":"2017","unstructured":"Gulamhusein AF, Kamath PS. 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The requirement for individual informed consent was waived by the Ethics Committee of Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin (approval reference: EA1\/146\/22), in accordance with applicable national regulations and the principles of the Declaration of Helsinki, given the non-interventional, retrospective nature of the study and the use of pseudonymised data. All data were handled in accordance with institutional data protection guidelines.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"474"}}