title: Low risk of bacteremia after endoscopic variceal therapy for esophageal varices: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Endoscopic variceal ligation (EVL) and endoscopic variceal sclerotherapy (EVS) are the main therapeutic procedures for the emergency treatment and secondary prophylaxis of esophageal varices in cirrhotics. Post-endoscopic bacteremia has been reported after EVS and EVL, but data on the frequency of bacteremia are conflicting. This study aims to provide incidences of bacteremia after EVS and EVL in different settings through meta-analysis.
  
  
  METHODS
  Only prospective or randomized studies were included in this meta-analysis. Binomial distribution was used to compute variance for each study. Random effects models were used as the final model for estimating the effect size and 95 % confidence interval. Adjusted effects were obtained using meta-regression analysis.
  
  
  RESULTS
  Nineteen prospective studies involving 1001 procedures in 587 patients were included in the meta-analysis on the risk of bacteremia after EVS or EVL in cirrhotics with esophageal varices. The frequency of bacteremia after endoscopic variceal therapy was 13 %. The frequency of bacteremia after EVS (17 %) was higher than after EVL (6 %) with no statistically significant difference (P = 0.106). The frequency of bacteremia after elective EVS (14 %) was significantly less than after emergency EVS (22 %) (P < 0.001). The frequency of bacteremia after elective EVL (7.6 %) was not significantly different from after emergency EVL (3.2 %) (P = 0.850).
  
  
  CONCLUSIONS
  The incidence of bacteremia is low in patients with cirrhosis and varices after esophageal variceal therapy. These results are consistent with our current guidelines that antibiotic prophylaxis before endoscopic variceal therapy is only necessary for bleeding patients.
authors.affiliation: Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Jia
authors.affiliation: Division of Biostatistics & Epidemiology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Alok
authors.initials: A
authors.lastname: Dwivedi
authors.affiliation: Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Sherif
authors.initials: S
authors.lastname: Elhanafi
authors.affiliation: Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Arleen
authors.initials: A
authors.lastname: Ortiz
authors.affiliation: Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Othman
authors.affiliation: Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Zuckerman