Bacteremia Following Endoscopic Variceal Sclerotherapy and Band Ligation at Ain Shams University Hospitals
Medhat Assem Ahmed;
Abstract
P
ortal hypertension commonly accompanies the presence of liver cirrhosis, and the development of esophageal varices (EV) is one of the major complications of portal hypertension (De Franchis & Primignani, 2001). The prevalence of EV in patients with liver cirrhosis ranges from 35% to 70%, and the reported mortality from variceal bleeding ranges from 17% to 57% (Jensen, 2002).
The frequent occurrence of bacterial infections in cirrhotic patients probably results from deficient defense mechanisms (Rosa et al., 2000). Accordingly, systemic alterations have been described such as complement deficiency, alterations in immunoglobulins levels (Almeida & Mattos, 1997), defects in opsonic activity as well as in serum bactericidal activity (Wyke, 1987), decrease in the phagocytic activity of the reticuloendothelial system (Rimola et al., 1981), and neutrophilic dysfunction (Fiuza et al., 2000).
Cirrhotic patients, particularly those with a poor liver function and those admitted with gastrointestinal hemorrhage, are at a high risk of developing acute bacterial infections. Mortality related to infections in cirrhosis has decreased over the years as a result of earlier diagnosis and effective treatment (Kamal et al., 2000 and Fernandez et al., 2002).
In a comparative study of the prevalence of bacterial infections between hospitalized cirrhotic patients with and without upper gastrointestinal bleeding (UGB), it was found that the prevalence of infections was greater among patients with UGB (54%) than in those without UGB (35%) (Almeida et al., 2001).
Diagnostic upper GIT endoscopy, Endoscopic Variceal Sclerotherapy (EVS) and Endoscopic Variceal Ligation (EVL) may contribute to bacterial infections due to associated disruption of the natural barriers (Almeida et al., 2001). It has been previously reported that the passage of a fiberoptic endoscope into the upper GIT might be associated with mucosal trauma and subsequent translocation of native microorganisms, and that this might be particularly likely to occur when mucosal biopsy specimens were obtained. For simple esophago-gastro-dudenoscopy (EGD), with or without biopsies, the reportedrate of bacteremia ranges from 0% to 8%, with a mean frequency of 4.1% (O'Connor et al., 1983).
Transient bacteremia after injection sclerotherapy of esophageal varices has been reported with a mean frequency of 14.6% (range 0% to 52.5%) (Kulkarni et al., 1999). Factors implicated to explain this wide variation include contaminated water (Brayko et al., 1985), length of the injection needle (Snady et al., 1985) and the presence of acute bleeding (or emergent sclerotherapy) (Ho et al., 1991). Although usually lasting less than 30 minutes, bacteremia in some cases has been observed as long as 24 hours (Cohen et al., 1983).
ortal hypertension commonly accompanies the presence of liver cirrhosis, and the development of esophageal varices (EV) is one of the major complications of portal hypertension (De Franchis & Primignani, 2001). The prevalence of EV in patients with liver cirrhosis ranges from 35% to 70%, and the reported mortality from variceal bleeding ranges from 17% to 57% (Jensen, 2002).
The frequent occurrence of bacterial infections in cirrhotic patients probably results from deficient defense mechanisms (Rosa et al., 2000). Accordingly, systemic alterations have been described such as complement deficiency, alterations in immunoglobulins levels (Almeida & Mattos, 1997), defects in opsonic activity as well as in serum bactericidal activity (Wyke, 1987), decrease in the phagocytic activity of the reticuloendothelial system (Rimola et al., 1981), and neutrophilic dysfunction (Fiuza et al., 2000).
Cirrhotic patients, particularly those with a poor liver function and those admitted with gastrointestinal hemorrhage, are at a high risk of developing acute bacterial infections. Mortality related to infections in cirrhosis has decreased over the years as a result of earlier diagnosis and effective treatment (Kamal et al., 2000 and Fernandez et al., 2002).
In a comparative study of the prevalence of bacterial infections between hospitalized cirrhotic patients with and without upper gastrointestinal bleeding (UGB), it was found that the prevalence of infections was greater among patients with UGB (54%) than in those without UGB (35%) (Almeida et al., 2001).
Diagnostic upper GIT endoscopy, Endoscopic Variceal Sclerotherapy (EVS) and Endoscopic Variceal Ligation (EVL) may contribute to bacterial infections due to associated disruption of the natural barriers (Almeida et al., 2001). It has been previously reported that the passage of a fiberoptic endoscope into the upper GIT might be associated with mucosal trauma and subsequent translocation of native microorganisms, and that this might be particularly likely to occur when mucosal biopsy specimens were obtained. For simple esophago-gastro-dudenoscopy (EGD), with or without biopsies, the reportedrate of bacteremia ranges from 0% to 8%, with a mean frequency of 4.1% (O'Connor et al., 1983).
Transient bacteremia after injection sclerotherapy of esophageal varices has been reported with a mean frequency of 14.6% (range 0% to 52.5%) (Kulkarni et al., 1999). Factors implicated to explain this wide variation include contaminated water (Brayko et al., 1985), length of the injection needle (Snady et al., 1985) and the presence of acute bleeding (or emergent sclerotherapy) (Ho et al., 1991). Although usually lasting less than 30 minutes, bacteremia in some cases has been observed as long as 24 hours (Cohen et al., 1983).
Other data
| Title | Bacteremia Following Endoscopic Variceal Sclerotherapy and Band Ligation at Ain Shams University Hospitals | Other Titles | العدوي البكتيرية بالدم عقب حقن وربط الدوالي بالمنظار فى مستشفيات جامعة عين شمس | Authors | Medhat Assem Ahmed | Issue Date | 2015 |
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