Risk of bacteremia in bleeding and nonbleeding gastric varices after endoscopic injection of cyanoacrylate

Background and study aim: Bacteremia is common in cirrhosis with gastrointestinal bleeding, including variceal bleeding. Elective esophageal sclerotherapy and banding have been reported to cause bacteremia. The risk associated with therapeutic endoscopy in patients with gastric varices has not yet been reported. This study was conducted to compare the risk of bacteremia between patients with active gastric variceal bleeding and those with gastric varices that were not actively bleeding who underwent N-butyl-2-cyanoacrylate injection.

Patients and methods: Patients were categorized into three groups: group I, patients with bleeding gastric varices who underwent cyanoacrylate injection for hemostasis (n = 20); group II, patients who underwent elective cyanoacrylate injection for further obliteration of gastric varices (n = 18); and group III, patients with cirrhosis who underwent endoscopic surveillance for varices, and patients with gastric varices who presented for a follow-up endoscopy without a requirement for treatment (n = 17). Blood culture was obtained before and 5 minutes and 3 hours after endoscopy. Needle tips were also sent for culture.

Results: Before procedures, blood cultures were positive in 4 patients (20 %) from group I. The number of positive blood cultures in group I at 5 minutes and 3 hours after the procedure were 3 (15 %) and 2 (10 %) respectively. The identified organisms were: Klebsiella pneumoniae (2), Escherichia coli (1), Vibrio cholerae non-O1 (1). No patient from group II had a positive culture at any point of blood drawn. Only one in group III had a positive culture, for Streptococcus mitis at 5 minutes. No clinical evidence of infections occurred in any patient. Needle-tip cultures grew mainly organisms from the oral and gastrointestinal tracts.

Conclusions: Elective cyanoacrylate injection for nonbleeding gastric varices is not associated with significant bacteremia or infection. For this reason, prophylactic antibiotics may not be needed in this patient group. By contrast, prophylactic antibiotics are strongly recommended for patients with bleeding gastric varices undergoing cyanoacrylate injection.

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