title: Bacteremia and endotoxemia after endoscopic submucosal dissection for gastric neoplasia: pilot study.
abstract: BACKGROUND
  Because the invasive procedure of endoscopic submucosal dissection (ESD) entails a large mucosal defect which is left open, with extensive submucosal exposure to the indigenous bacterial flora, the procedure may have a substantial risk for bacteremia. Our aim was to examine gastric ESD-related bacteremia and endotoxemia in gastric neoplasia patients.
  
  
  METHODS
  In patients who underwent ESD for superficial gastric neoplasia, blood cultures and plasma endotoxin measurements were done before, immediately after, and on day 2 after ESD. Clinically manifest infections and inflammatory markers, including C-reactive protein (CRP) and white blood cells, were monitored.
  
  
  RESULTS
  Fifty patients (aged 69 ± 8 years; mean ± SD) were enrolled. The diameter of the resected specimens was 38 ± 18 mm and the procedure time of ESD was 66 ± 53 min. Two percent (2/100) of blood cultures after ESD were positive, with findings as follows: Propionibacterium species immediately after ESD, and Enterobacter aerogenes on day 2 after ESD, but no clinically manifest infection was observed. In 30% of the enrolled patients, CRP on day 2 after ESD had increased to levels higher than 1.0 mg/l. Plasma endotoxin levels, immediately after and on day 2 after ESD were correlated with CRP levels on day 2 after ESD.
  
  
  CONCLUSIONS
  In spite of the invasive procedure with massive submucosal exposure to the indigenous bacterial flora, gastric ESD has a low risk for bacteremia. Gastric ESD-related endotoxemia may be linked to inflammatory reactions such as those shown by the increase of CRP or fever observed after ESD.
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, Japan. masa-kato@jikei.ac.jp
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kato
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
authors.forename: Toru
authors.initials: T
authors.lastname: Obata
authors.forename: Jin
authors.initials: J
authors.lastname: Yonezawa
authors.forename: Hirobumi
authors.initials: H
authors.lastname: Toyoizumi
authors.forename: Noboru
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Yukinaga
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Muneo
authors.initials: M
authors.lastname: Kawamura
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D002097:C-Reactive Protein / Q000378:metabolism; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D019446:Endotoxemia / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery
chemical_list: D002097:C-Reactive Protein