Refractory post-band ligation bleeding misdiagnosed as esophageal varix rupture caused by primary biliary cirrhosis: A case report

A 71-year-old woman had refractory post-band ligation esophageal bleeding although emergency EVL was carried out nine times in total. She was originally considered the esophageal variceal hemorrhage in Primary Biliary Cirrhosis (PBC). Through discussion at a multidisciplinary meeting, we could reach an appropriate diagnosis of PBC and incomplete CREST overlap syndrome. It was difficult to distinguish hemorrhagic telangiectasia from bleeding esophageal varices, and argon plasma coagulation safely reduced the risk of rebleeding and necessity of emergency endoscopy. We learned again a valuable lesson that interprofessional communication is essential to overcome diagnostic error and cognitive bias in patients with refractory treatment. Keywords: cognitive bias; diagnostic error; interprofessional communication; PBC and CREST overlap syndrome; refractory post-band ligation bleeding.