Bonilha Danielle Queiroz, Correia Lucianna Motta, Monaghan Marie, Lenz Luciano, Santos Marcus, Libera Ermelindo Della
Universidade Federal de São Paulo, Brasil.
Arq Gastroenterol. 2011 Oct-Dec;48(4):248-51. doi: 10.1590/s0004-28032011000400006.
Band ligation (BL) is the most appropriate endoscopic treatment for acute bleeding or prophylaxis of esophageal variceal bleeding. Sclerotherapy with N-butyl-2-cyanoacrylate (CY) can be an alternative for patients with advanced liver disease. Bacteremia is an infrequent complication after BL while the bacteremia rate following treatment with CY for esophageal varices remains unknown.
To evaluate and compare the incidence of transient bacteremia between cirrhotic patients submitted to diagnostic endoscopy, CY and BL for treatment of esophageal varices.
A prospective study comprising the period from 2004 to 2007 was conducted at Hospital of Universidade Federal de São Paulo, UNIFESP, SP, Brazil. Cirrhotic patients with advanced liver disease (Child-Pugh B or C) were enrolled. The patients were divided into two groups according treatment: BL Group (patients undergoing band ligation, n = 20) and CY Group (patients receiving cyanoacrylate injection for esophageal variceal, n = 18). Cirrhotic patients with no esophageal varices or without indication for endoscopic treatment were recruited as control (diagnostic group n = 20). Bacteremia was evaluated by blood culture at baseline and 30 minutes after the procedure.
After 137 scheduled endoscopic procedures, none of the 58 patients had fever or any sign suggestive of infection. All baseline cultures were negative. No positive cultures were observed after CY or in the control group - diagnostic endoscopy. Three (4.6 %) positive cultures were found out of the 65 sessions of band ligation (P = 0.187). Two of these samples were positive for coagulase-negative staphylococcus, which could be regarded as a contaminant. The isolated microorganism in the other case was Klebsiella oxytoca. The patient in this case presented no evidence of immunodeficiency except liver disease.
There was no significant difference in bacteremia rate between these three groups. BL or CY injection for non-bleeding esophageal varices may be considered as low-risk procedures regarding bacteremia even when performed on patients with advanced liver disease.
套扎术（BL）是治疗急性出血或预防食管静脉曲张出血最适宜的内镜治疗方法。用N-丁基-2-氰基丙烯酸酯（CY）进行硬化治疗可作为晚期肝病患者的替代治疗方法。菌血症是套扎术后不常见的并发症，而用CY治疗食管静脉曲张后的菌血症发生率尚不清楚。
评估并比较接受诊断性内镜检查、用CY和BL治疗食管静脉曲张的肝硬化患者发生短暂菌血症的发生率。
2004年至2007年期间，在巴西圣保罗联邦大学医院进行了一项前瞻性研究。纳入晚期肝病（Child-Pugh B级或C级）的肝硬化患者。根据治疗方法将患者分为两组：BL组（接受套扎术的患者，n = 20）和CY组（接受氰基丙烯酸酯注射治疗食管静脉曲张的患者，n = 18）。招募无食管静脉曲张或无内镜治疗指征的肝硬化患者作为对照组（诊断组n = 20）。在基线和术后30分钟通过血培养评估菌血症。
在137例预定的内镜检查术后，58例患者中无一例出现发热或任何提示感染的迹象。所有基线培养均为阴性。在用CY治疗后或对照组——诊断性内镜检查后均未观察到阳性培养结果。在65次套扎术中，有3次（4.6%）培养结果为阳性（P = 0.187）。其中两个样本凝固酶阴性葡萄球菌呈阳性，可视为污染物。另一例分离出的微生物是产酸克雷伯菌。该病例中的患者除肝病外无免疫缺陷证据。
这三组之间的菌血症发生率无显著差异。即使是对晚期肝病患者进行非出血性食管静脉曲张的套扎术或CY注射，就菌血症而言也可被视为低风险操作。
