Herwig Cerwenka, Peter Schemmer, Department of Surgery, Medical University of Graz, 8036 Graz, Austria.
World J Gastroenterol. 2017 Aug 14;23(30):5457-5459. doi: 10.3748/wjg.v23.i30.5457.
This is an editorial comment on a recent publication reporting an increased rate of pyogenic liver abscesses (PLAs) after upper gastrointestinal panendoscopy. Its aim is to critically highlight the findings, limitations and potential clinical implications of this study. Issues of the mucosal barrier, the microbial flora, administration of antibiotics and underlying diseases are discussed. The probability of PLAs after endoscopies is not exactly known and the length of the "incubation period" remains unclear, but a possible causality should already suffice to make us think how to avoid them. Especially in patients with risk factors such as diabetes mellitus, end-stage renal disease, liver cirrhosis, biliary tract infection, and malignancies, the potential risk for PLAs should be considered. Unnecessary insufflation during endoscopy (causing mucosal stretching and microscopic tears) as well as mucosal damage (by direct abrasion with the scope) should be avoided in order to limit the invasiveness of the procedure as much as possible. And, in everyday routine, it should be kept in mind that in patients after endoscopy, especially in those with a breach of the mucosal barrier and significant comorbidities, PLAs can potentially develop and require timely administration of antibiotics as well as further diagnostic and therapeutic steps.
这是一篇针对最近一篇报道上消化道内镜检查后化脓性肝脓肿（PLA）发生率增加的文献的评论，旨在批判性地突出该研究的发现、局限性和潜在的临床意义。讨论了黏膜屏障、微生物菌群、抗生素的使用和潜在疾病等问题。内镜检查后 PLA 的可能性尚不清楚，“潜伏期”也不清楚，但已经足以让我们考虑如何预防它们。特别是对于有糖尿病、终末期肾病、肝硬化、胆道感染和恶性肿瘤等危险因素的患者，应考虑潜在的 PLA 风险。为了尽可能减少检查的侵袭性，应避免内镜检查时不必要的充气（导致黏膜拉伸和微小撕裂）以及黏膜损伤（直接与内镜摩擦造成）。在日常实践中，应牢记在接受内镜检查后的患者中，尤其是在黏膜屏障受损和存在显著合并症的患者中，PLA 可能会发生，并需要及时使用抗生素以及进一步的诊断和治疗措施。
