Bacteremia after injection sclerotherapy and band ligation for oesophageal varices: a comparative study

ABSTRACT

A comparative trial was conducted to study the occurrence of bacteremia after oesophageal endoscopic injection sclerotherapy [EIS] and band ligation [EBL] in forty Egyptian patients with portal hypertension. Twenty patients were subjected to EIS and twenty patients underwent EBL The Two groups were well matched as regards clinical, laboratory, ultrasonographic data, endoscopic findings, modified Child's classification and aetiology of portal hypertension. Aerobic and anaerobic blood cultures were done for all patients before, 30 minutes and 24 hours after the procedures. Throat cultures and cultures of the bands used were done before the procedures. The injector and tip of the endoscope were as well cultured before and after the procedure. Serum Interleukin-[6] [IL-[6]] and polymorphnuclear elastase enzyme were also measured before, 30 minutes and 24 hours after the procedures as parameters of infection. Aerobic blood cultures were positive in two [10%] patients of the EIS group. One yielded a coagulase negative Staphylococcus strain after24 hours, and the other yielded Klebsiella pneumoniae after 30 minutes and 24 hours. The two organisms were also isolated from the patients' throats. Patients of the EBL group gave negative results. All anaerobic cultures were negative. IL-[6] and elastase enzyme had increased after both procedures. Mean level of IL-[6] was higher in EIS group than EBL group after 30 minutes and 24 hours. The latter difference was significant. [42.67 +/- 4.88 in EIS vs. 37.09 1 +/- 5.65 in EBL, p< 0.01]. Mean level of elastase enzyme also showed a significantly higher level in EIS group than EBL group only 24 hours after the procedures [49. 32 +/- 4.74 vs. 44.671 +/- 0.52 in both groups respectively, p < 0.01]. These data suggest that the incidence of bacteremia is less common after band ligation than sclerotherapy. Band ligation could be safer than injection sclerotherapy especially in patients with risk of infections