Low risk of bacteremia after endoscopic variceal therapy for esophageal varices: a systematic review and meta-analysis

Jia, Yi; Dwivedi, Alok; Elhanafi, Sherif; Ortiz, Arleen M.; Othman, Mohamed O.; Zuckerman, Marc J.

doi:10.1055/s-0034-1392552

Cited by 10 publications

(9 citation statements)

References 42 publications

(80 reference statements)

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“…We recently published a meta-analysis on bacteremia after both EVL and EVS and found only limited data on bacteremia after EVL ( 24 ). The data in this study had not yet been reported and so was not included in the meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Study on the Risk of Bacteremia in Banding versus Sclerotherapy of Esophageal Varices

et al. 2016

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BackgroundEsophageal variceal banding may be less likely to cause bacteremia than sclerotherapy. The existing data about the frequency of bacteremia after esophageal variceal banding are conflicting, and few studies include both banding and sclerotherapy.AimsWe conducted a prospective randomized controlled trial to compare the frequency of bacteremia after esophageal variceal banding and sclerotherapy.MethodsOver a 2-year period, patients with liver disease admitted for upper gastrointestinal bleeding or for outpatient elective variceal therapy were enrolled. New patients were randomized preprocedure to either banding or sclerotherapy, and subsequent sessions utilized the initial procedure. The groups consisted of banding, sclerotherapy, and endoscopy without variceal therapy. Subjects underwent endoscopy by one out of three gastroenterologists. Blood cultures were obtained 5 min before and 30 min after endoscopy to check for bacteremia.ResultsPostendoscopic blood cultures were positive following 4 out of 139 (2.9%) sessions: 1 sclerotherapy and 3 control sessions. All postendoscopic positive blood cultures were found following emergency sessions (4/92, 4.3%). One pre-endoscopic blood culture was positive in a patient with emergency banding. The rates of positive postendoscopic blood cultures among groups with emergency banding (0/22, 0%), emergency sclerotherapy (1/41, 2.3%), and emergency control (3/29, 10.3%) were not significantly different. Postendoscopic positive blood cultures were not found after elective sessions with either banding or sclerotherapy.ConclusionsPostendoscopic bacteremia was infrequent following emergency endoscopy in patients with esophageal variceal bleeding. Bacteremia was not found after esophageal variceal banding, although this was not significantly less frequent than after sclerotherapy. Postendoscopic bacteremia was not associated with elective variceal therapy.

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Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Study on the Risk of Bacteremia in Banding versus Sclerotherapy of Esophageal Varices

et al. 2016

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“…La frecuencia de bacteriemia en pacientes sometidos a escleroterapia fue mayor (17%) comaprada con la observada (6%) en pacientes tratados mediante ligadura (p = 0.106). La incidencia de bacteriemia es baja en pacientes con cirrosis sometidos a escleroterapia o ligadura, sin sangrado activo, por lo que no se recomienda profilaxis con antibióticos 16 .…”

Section: Procedimientos Endoscópicos Terapéuticos De Tubo Digestivounclassified

“…Procedimientos asociados a riesgo de infección que se benefician de profilaxis antibiótica Procedimiento Colangiografía endoscópica con drenaje incompleto de vía biliar Colangioscopia con toma de biopsias Aspiración con aguja fina de quistes mediastinales (procedimiento no recomendado por alta mortalidad) Aspiración con aguja fina de quistes de páncreas Colocación de sondas de alimentación endoscópica percutánea Tabla 3. Procedimientos asociados con bajo y alto riesgo de bacteriemia [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] 20. procedimiento seguro, sin embargo la tasa y tipo de complicaciones es variable, según la población de estudio; la más frecuente es la infección periestomal, cuya prevalencia varía entre 5 y 30% de acuerdo con lo reportado en los diversos estudios 17 .…”

Section: Riesgo De Bacteriemia E Infección Por Accesos Enterales Percutáneos Endoscópicosunclassified

Guía de prevención de infecciones y uso de antibióticos profilácticos en endoscopia

Blanco-Vela¹,

Peláez-Luna

Martínez-García³

et al. 2021

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La endoscopia tiene el riesgo inherente de introducir bacterias en el organismo a través de las membranas mucosas, lo que podría ocasionar bacteriemia y posterior infección. El valor del uso de antibióticos profilácticos en pacientes que requieren procedimientos endoscópicos ha sido objeto de debate y su uso debe considerar el riesgo individual de cada paciente para desarrollar infecciones. La Asociación Mexicana de Endoscopia Gastrointestinal convocó a un grupo de endoscopistas, gastroenterólogos y enfermeros especializados en procesamiento de endoscopios con la finalidad de evaluar de manera crítica la evidencia científica y proponer estrategias para el uso racional de antibióticos mediante un consenso.

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“…The rationale behind prophylaxis is the risk of bacteremia, which occurs in 3%-6% of cases, but it becomes clinically relevant only in a minority. A recently published systematic review and meta-analysis investigated this topic including 1001 procedures in 587 patients from 19 studies[ 38 ]. Overall, the frequency of bacteremia was 17% and 6% after sclerosis and band ligation, respectively.…”

Section: Variceal Bleedingmentioning

confidence: 99%

Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice

Ferrarese¹,

Passigato²,

Cusumano³

et al. 2021

WJH

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Patients with cirrhosis show an increased susceptibility to infection due to disease-related immune-dysfunction. Bacterial infection therefore represents a common, often detrimental event in patients with advanced liver disease, since it can worsen portal hypertension and impair the function of hepatic and extra-hepatic organs. Among pharmacological strategies to prevent infection, antibiotic prophylaxis remains the first-choice, especially in high-risk groups, such as patients with acute variceal bleeding, low ascitic fluid proteins, and prior episodes of spontaneous bacterial peritonitis. Nevertheless, antibiotic prophylaxis has to deal with the changing bacterial epidemiology in cirrhosis, with increased rates of gram-positive bacteria and multidrug resistant rods, warnings about quinolones-related side effects, and low prescription adherence. Short-term antibiotic prophylaxis is applied in many other settings during hospitalization, such as before interventional or surgical procedures, but often without knowledge of local bacterial epidemiology and without strict adherence to antimicrobial stewardship. This paper offers a detailed overview on the application of antibiotic prophylaxis in cirrhosis, according to the current evidence.

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Low risk of bacteremia after endoscopic variceal therapy for esophageal varices: a systematic review and meta-analysis

Cited by 10 publications

References 42 publications

A Prospective Randomized Study on the Risk of Bacteremia in Banding versus Sclerotherapy of Esophageal Varices

A Prospective Randomized Study on the Risk of Bacteremia in Banding versus Sclerotherapy of Esophageal Varices

Guía de prevención de infecciones y uso de antibióticos profilácticos en endoscopia

Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice

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