Pattern of bacteraemia following endoscopic elective oesophageal injection sclerotherapy and band ligation in cirrhotic patients

Abstract 

Background and study aims

Gastrointestinal endoscopy is an invasive technique and it may be associated with a risk of bacteraemia, especially if endoscopy is associated with an intervention such as injection sclerotherapy or band ligation. The aim of the work is to investigate the incidence of bacteraemia following elective elastic band ligation and elective injection sclerotherapy in cirrhotic patients.

Patients and methods

Our study included 80 cirrhotic patients with grade III–IV oesophageal varices divided into three groups: 30 patients treated with elective injection sclerotherapy, 30 patients treated with elective band ligation and 20 patients underwent diagnostic upper endoscopy and served as control. All patients were subjected to full clinical evaluation, abdominal ultrasonography and lab investigations, including blood culture before and after the endoscopic procedure.

Results

No positive blood cultures were detected before the technique. Seven patients (8.75%) had positive blood culture after endoscopy; six of them (20%) were in the injection sclerotherapy group, one patient (3.33%) in the band ligation group and none in the upper endoscopy group. Positive blood culture was more frequent in Child C patients (four patients) compared to Child B (two patients) and Child A patients (one patient) with statistically significant difference. Three types of micro-organisms were isolated: Acinetobacter, alpha haemolytic streptococci and coagulase negative staphylococci.

Conclusion

The rate of bacteraemia is higher in the injection sclerotherapy group compared with the band ligation group, especially in Child C patients.

Keywords: Bacteraemia, Injection sclerotherapy, Band ligation, Cirrhosis