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

Abstract

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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“…In the current study, about 48% of patients had at least one chronic illness, whereas the most frequent one was chronic liver disease (44%), hypertension (12%), diabetes mellitus (12%) and cancer (5%). Similar data was revealed by Zucherman et al 9 who showed Patients who have had endoscopic treatment for esophageal varices and chronic liver disease are more likely to develop bacteremia and infections.…”

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