Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA.
Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center , El Paso, Texas , USA.
Front Med (Lausanne). 2016 May 2;3:16. doi: 10.3389/fmed.2016.00016. eCollection 2016.
Esophageal 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.
We conducted a prospective randomized controlled trial to compare the frequency of bacteremia after esophageal variceal banding and sclerotherapy.
Over 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.
Postendoscopic 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.
Postendoscopic 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.
食管静脉曲张套扎术引起菌血症的可能性低于硬化疗法。关于食管静脉曲张套扎术后菌血症发生频率的现有数据相互矛盾，且很少有研究同时包括套扎术和硬化疗法。
我们进行了一项前瞻性随机对照试验，比较食管静脉曲张套扎术和硬化疗法后菌血症的发生频率。
在两年期间，将因上消化道出血或门诊择期行静脉曲张治疗而住院的肝病患者纳入研究。新患者在术前随机分为套扎术组或硬化疗法组，随后的治疗采用初始治疗方案。三组分别为套扎术组、硬化疗法组和未行静脉曲张治疗的内镜组。所有患者均由三位胃肠病学家之一进行内镜检查。在进行内镜检查前 5 分钟和检查后 30 分钟采集血培养，以检查菌血症。
139 次内镜检查中有 4 次（2.9%）检查后血培养阳性：1 次硬化疗法和 3 次对照组。所有内镜检查后阳性的血培养均来自紧急内镜检查（4/92，4.3%）。1 例行紧急套扎术的患者在术前血培养阳性。紧急套扎术组（0/22，0%）、紧急硬化疗法组（1/41，2.3%）和紧急对照组（3/29，10.3%）的内镜检查后血培养阳性率无显著差异。行择期套扎术或硬化疗法后，未发现内镜检查后血培养阳性。
食管静脉曲张出血患者行紧急内镜检查后，菌血症发生率较低。尽管食管静脉曲张套扎术后未发现菌血症，但与硬化疗法相比，其发生率并无显著降低。内镜检查后菌血症与择期静脉曲张治疗无关。
