Bacteremia in cirrhotic patients submitted to endoscopic band ligation of esophageal varices

Abstract

-Background -Endoscopic procedures can develop bacteremia. Patients with chronic liver disease are more predisposed to undergo bacteremia and infections because they are immunocompromised. Aims -The purpose of this study was to determine the incidence of bacteremia in cirrhotics submitted to endoscopic variceal ligation. Methods -Three groups of 40 patients each were studied. One group was made up of patients with cirrhosis who were submitted to ligation, a second group was composed of cirrhotics who underwent esophagogastroduodenoscopy only, and a third group was composed of patients without liver disease who underwent esophagogastroduodenoscopy. Blood was sampled from all patients for culture, both in aerobic and in anaerobic mediums, immediately before endoscopy and at 5 and 30 minutes after its completion. Results -Blood culture was positive in 6 samples. In 4 of these, the bacteria (Staphylococcus hominis hominis, Staphylococcus auricularis, Acinetobacter lwoffii, and coagulase-negative staphylococcus) were isolated before the endoscopic procedure and thus were considered as contamination. In the ligation group, a streptococcus of the viridans group was isolated 5 minutes after the procedure, and in the cirrhosis without ligation group, a Staphylococcus epidermidis was isolated at 30 minutes. None of the patients showed clinical evidence of infection. Conclusions -The bacteremia incidence in cirrhotic patients submitted to variceal ligation was 2.5%, showing no difference from the control groups.

Incidence of Bacteremia After Endoscopic Variceal Ligation of Oesophageal Varices in Cirrhotic Patients

“…Rhor reported 3 bands application in their two cases of bacteremia 11 . Similarly Maulaz also reports 3 bands application in their single bacteremic case 9 . The authors in remaining studies have not mention about the band numbers.…”

“…in same department in 2007 16 . This compared to other countries like India and Brazil, alcohol was a major cause of cirrhosis 8,9 .…”

“…Study by Maulaz also shared this reason for not supporting the view of bacteremia being common in patients with severe liver dysfunction 9 .…”

“…Various prospective studies have been conducted to evaluate the frequency of occurrence of post EVL bacteremia with incidence ranging from 0 % to 25% [8][9][10][11][12][13][14] .…”

Prospective study of bacteremia rate after elective band ligation and sclerotherapy with cyanoacrylate for esophageal varices in patients with advanced liver disease

“…This rate can be higher following therapeutic procedures (10,14) . Moreover, patients with chronic liver disease (especially in advanced stages) are more predisposed to bacteremia and infections secondary to their immunocompromised state (9,12) . Band ligation (BL) is the most appropriate endoscopic treatment for acute bleeding or primary and secondary prophylaxis of esophageal variceal bleeding (7) .…”