title: Prospective study of bacteremia rate after elective band ligation and sclerotherapy with cyanoacrylate for esophageal varices in patients with advanced liver disease.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To evaluate and compare the incidence of transient bacteremia between cirrhotic patients submitted to diagnostic endoscopy, CY and BL for treatment of esophageal varices.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Universidade Federal de São Paulo, Brasil. daniellerossana@hotmail.com
authors.forename: Danielle Queiroz
authors.initials: DQ
authors.lastname: Bonilha
authors.forename: Lucianna Motta
authors.initials: LM
authors.lastname: Correia
authors.forename: Marie
authors.initials: M
authors.lastname: Monaghan
authors.forename: Luciano
authors.initials: L
authors.lastname: Lenz
authors.forename: Marcus
authors.initials: M
authors.lastname: Santos
authors.forename: Ermelindo Della
authors.initials: ED
authors.lastname: Libera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D004659:Enbucrilate / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004659:Enbucrilate