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DOI: 10.1055/s-2008-1077294
© Georg Thieme Verlag KG Stuttgart · New York
Risk of bacteremia in bleeding and nonbleeding gastric varices after endoscopic injection of cyanoacrylate
Publication History
submitted 8 November 2007
accepted after revision 11 March 2008
Publication Date:
17 June 2008 (online)
![](https://www.thieme-connect.de/media/endoscopy/200808/lookinside/thumbnails/10.1055-s-2008-1077294-1.jpg)
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.
References
- 1 Wyke R J. Problems of bacterial infection in patients with liver disease. Gut. 1987; 28 623-641
- 2 Thulstrup A M, Sørensen H T, Schønheyder H C. et al . Population-based study of the risk and short-term prognosis for bacteremia in patients with liver cirrhosis. Clin Infect Dis. 2000; 31 1357-1361
- 3 Nelson D B. Infectious disease complication of GI endoscopy: Part I, endogenous infection. Gastrointest Endosc. 2003; 57 546-556
- 4 Sauerbruch T, Holl J, Ruckdeschel G. et al . Bacteriaemia associated with endoscopic sclerotherapy of oesophageal varices. Endoscopy. 1985; 17 170-172
- 5 Cohen L B, Korsten M A, Scherl E J. et al . Bacteremia after endoscopic injection sclerosis. Gastrointest Endosc. 1983; 29 198-200
- 6 Dhiman R K, Chawla Y, Taneja S. et al . Endoscopic sclerotherapy of gastric variceal bleeding with N-butyl-2-cyanoacrylate. J Clin Gastroenterol. 2002; 35 222-227
- 7 Noophun P, Kongkam P, Gonlachanvit S, Rerknimitr R. Bleeding gastric varices: results of endoscopic injection with cyanoacrylate at King Chulalongkorn Memorial Hospital. World J Gastroenterol. 2005; 11 7531-7535
- 8 Akahoshi T, Hashizume M, Shimabukuro R. et al . Long-term results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding: a 10-year experience. Surgery. 2002; 131(1 Suppl) S176-S181
- 9 Kind R, Guglielmi A, Rodella L. et al . Bucrylate treatment of bleeding gastric varices: 12 years’ experience. Endoscopy. 2000; 32 512-519
- 10 Chen W C, Hou M C, Lin H C. et al . Bacteremia after endoscopic injection of N-butyl-2-cyanoacrylate for gastric variceal bleeding. Gastrointest Endosc. 2001; 54 214-218
- 11 Fenzl T C, Fenzl R E, Harris L. Antimicrobial properties of alkyl-2-cyanoacrylate tissue adhesives in vitro. Am J Ophthalmol. 1983; 95 125-126
- 12 Eiferman R A, Snyder J W. Antibacterial effect of cyanoacrylate glue. Arch Ophthalmol. 1983; 101 958-960
- 13 Sarin S K, Kumar A. Gastric varices: profile, classification, and management. Am J Gastroenterol. 1989; 84 1244-1249
- 14 Castells A, Bruix J, Ayuso C. et al . Transarterial embolization for hepatocellular carcinoma. Antibiotic prophylaxis and clinical meaning of postembolization fever. J Hepatol. 1995; 22 410-415
- 15 Ho H, Zuckerman M J, Wassem C. A prospective controlled study of the risk of bacteremia in emergency sclerotherapy of esophageal varices. Gastroenterology. 1991; 101 1642-1648
- 16 Kulkarni S G, Parikh S S, Dhawan P S. et al . High frequency of bacteremia with endoscopic treatment of esophageal varices in advanced cirrhosis. Indian J Gastroenterol. 1999; 18 143-145
- 17 Sarin S K, Agarwal S R. Gastric varices and portal hypertensive gastropathy. Clin Liver Dis. 2001; 5 727-767
- 18 Rauws E A. Prevention of recurrent variceal bleeding. Scand J Gastroenterol Suppl. 1999; 230 71-75
- 19 Lo G H, Liang H L, Chen W C. et al . A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy. 2007; 39 679-685
- 20 Willenberg E, Morenz J, Krumbholz S. et al . Bacteriostatic behavior of the tissue adhesive Fimomed (n-butyl-alpha-cyanoacrylate]. Zentralbl Neurochir. 1978; 39 103-107
- 21 Narang U, Mainwaring L, Spath G, Barefoot J. In-vitro analysis for microbial barrier properties of 2-octyl cyanoacrylate-derived wound treatment films. J Cutan Med Surg. 2003; 7 13-19
- 22 Hao W L, Lee Y K. Microflora of the gastrointestinal tract: a review. Methods Mol Biol. 2004; 268 491-502
- 23 Dickey W, Porter K G. Gastric mucosal tears occurring during endoscopy: might an endoscope defect be responsible?. Endoscopy. 1994; 26 713-714
- 24 Kozarek R A, Earnest D L, Silverstein M E, Smith R G. Air-pressure-induced colon injury during diagnostic colonoscopy. Gastroenterology. 1980; 78 7-14
- 25 Rimola A, Bory F, Teres J. et al . Oral, nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhage. Hepatology. 1985; 5 463-467
- 26 Bernard B, Grangé J D, Khac E N. et al . Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology. 1999; 29 1655-1661
- 27 Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L. Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding. Cochrane Database Syst Rev. 2002; issue 2 art.no. CD002907
- 28 Bernard B, Cadranel J F, Valla D, Escolano S. et al . Prognostic significance of bacterial infection in bleeding cirrhotic patients: a prospective study. Gastroenterology. 1995; 108 1828-1834
- 29 Borzio M, Salerno F, Piantoni L. et al . Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis. 2001; 33 41
R. Rerknimitr, MD
Division of Gastroenterology
Department of Internal Medicine
Faculty of Medicine
Chulalongkorn University
Bangkok 10310
Thailand
Fax: +66-2-2527839
Email: Rungsun@pol.net