Kulkarni S G, Parikh S S, Dhawan P S, Chachad H, Jambavalikar M B, Koppikar G V, Kalro R H
Department of Gastroenterology, BYL Nair Hospital, Mumbai.
Indian J Gastroenterol. 1999 Oct-Nov;18(4):143-5.
The fregency of bacteremia after endoscopic variceal band ligation (EVL) is reported to be lower when compared to that after endoscopic variceal sclerotherapy (EVS). However, there are conflicting reports on the infectious sequelae after EVL.
To compare the frequency on bacteremia and infectious sequelae after EVL and EVS in patients with cirrhosis of liver.
Bacteremia and infectious sequelae were studied in 32 sessions of EVL in 18 cirrhotic patients (Child-Pugh class A-6, B-5, C-7), 30 sessions of EVS in 22 cirrhotic patients (Child-Pugh class A-2, B-5, C-15) and 14 diagnostic upper gastrointestinal endoscopies. Blood cultures were collected before, during and 30 minutes after the procedure. Patients were observed for infectious sequelae during subsequent hospitalization.
Before the procedure, bacteremia was present in 7/62 (11%) sessions. Significant bacteremia during and 30 min post-procedure developed in 8/32 (25%) and 12/30 (40%) of EVL and EVS sessions, respectively (p = ns), and in 1/14 (7%) upper gastrointestinal endoscopy sessions. There was more frequent bacteremia with severe liver disease (Child-Pugh class A-0/6, B-1/5. C-7/21; p = 0.09) in the EVL but not in the EVS group (Child-Pugh class A-1/3, B-2/5, C-9/22; p = ns). The incidence was higher with emergency sclerotherapy compared to elective sclerotherapy (6/8 [75%] vs 6/22 [27%]; p <0.01). One patient in the EVS group developed spontaneous bacterial peritonitis.
Bacteremia occurs frequently following EVL and EVS in patients with advanced liver diseases. In the EVS group it is more common after emergency sclerotherapy. This bacteremia is rarely associated with significant infectious sequelae.
据报道，与内镜下静脉曲张硬化治疗（EVS）相比，内镜下静脉曲张套扎术（EVL）后菌血症的发生率较低。然而，关于EVL后感染性后遗症的报道存在矛盾。
比较肝硬化患者接受EVL和EVS后菌血症和感染性后遗症的发生率。
对18例肝硬化患者（Child-Pugh A级6例、B级5例、C级7例）的32次EVL、22例肝硬化患者（Child-Pugh A级2例、B级5例、C级15例）的30次EVS以及14次诊断性上消化道内镜检查中的菌血症和感染性后遗症进行了研究。在操作前、操作期间和操作后30分钟采集血培养样本。在随后的住院期间观察患者的感染性后遗症。
操作前，62次操作中有7次（11%）存在菌血症。EVL和EVS操作期间及操作后30分钟分别有8/32次（25%）和12/30次（40%）出现显著菌血症（p=无显著性差异），上消化道内镜检查中有1/14次（7%）出现显著菌血症。EVL组中严重肝病（Child-Pugh A级0/6、B级1/5、C级7/21；p=0.09）患者的菌血症更常见，但EVS组（Child-Pugh A级1/3、B级2/5、C级9/22；p=无显著性差异）并非如此。与择期硬化治疗相比，急诊硬化治疗的发生率更高（6/8 [75%] 对6/22 [27%]；p<0.01）。EVS组有1例患者发生自发性细菌性腹膜炎。
晚期肝病患者接受EVL和EVS后菌血症频繁发生。在EVS组中，急诊硬化治疗后更为常见。这种菌血症很少伴有严重的感染性后遗症。
