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Bacterial peritonitis after elective endoscopic variceal ligation: a prospective study
The American Journal of Gastroenterology
|January 19, 2000
Summary
Endoscopic variceal ligation can cause bacteremia and peritonitis in patients with esophageal varices. Prophylactic antibiotics may be beneficial for high-risk cirrhosis patients.
Area of Science:
- Gastroenterology
- Hepatology
- Infectious Diseases
Background:
- Endoscopic variceal ligation is increasingly preferred over sclerotherapy for esophageal varices.
- While ligation has a lower bacteremia risk than sclerotherapy, peritonitis incidence is less understood.
- This study prospectively evaluates risks of bacteremia and peritonitis post-ligation.
Purpose of the Study:
- To determine the incidence of bacteremia and bacterial peritonitis following elective endoscopic variceal ligation.
- To investigate the relationship between bacteremia and peritonitis after the procedure.
Main Methods:
- 67 patients with esophageal varices and ascites underwent elective endoscopic variceal ligation.
- Ascitic fluid and blood cultures were obtained before and after the procedure.
- Ascitic fluid was re-evaluated 2-4 days post-procedure, regardless of symptoms.
Main Results:
- 11 patients (16.4%) developed asymptomatic bacteremia, primarily with Gram-positive organisms.
- No patients with bacteremia developed peritonitis.
- Two patients without bacteremia developed mild, febrile Escherichia coli peritonitis, successfully treated with antibiotics.
Conclusions:
- Elective endoscopic variceal ligation carries a risk of asymptomatic bacteremia and bacterial peritonitis.
- Peritonitis appears unrelated to bacteremia, with different causative organisms.
- Post-ligation peritonitis may stem from severe cirrhosis; prophylactic antibiotics are suggested for high-risk patients (Child's C, recent bleeding, prior peritonitis, immunosuppression).