Bacteraemia following oesophageal dilatation and oesophago-gastroscopy

Significant, but asymptomatic, bacteraemia after oesophageal dilatation with Hurst's bougies for oesophageal stricture or spasm was detected in six of 11 patients. No bacteraemia was identified in ten volunteers without oesophageal pathology, who underwent passage of the same dilators. After oesophago-gastroscopy significant bacteraemia was identified in one of ten patients examined. The predominant bacterial isolates were streptococci ("Streptococcus viridans" and non-haemolytic Streptococcus sp.). All the strains were sensitive in vitro to penicillin, amplicillin and cephalosporins. Any of these antibiotics are considered suitable for prophylactic use prior to performing oesophageal dilatation and upper gastrointestinal endoscopy in "at risk" patients. The risk of bacteraemia is much lower after endoscopy than oesophageal dilatation for stricture or oesophageal spasm. Mucosal trauma is concluded as the site of entry of pharyngeal commensals leading to bacteraemia; and the incidence of bacteraemia appears related to the degree of trauma to the oesophagus.