Bacteremia during esophageal variceal sclerotherapy: its cause and prevention

Eleven consecutive patients underwent a total of 34 esophageal variceal sclerotherapy (EVS) sessions for bleeding esophageal varices. Blood cultures were drawn pre-, intra-, and post-EVS. All pre- and post-EVS blood cultures were negative. Five of the initial nine patients studied were found to have positive blood cultures, drawn after a mean of six injections. Pseudomonas aeruginosa was cultured from the blood in four patients and Flavobacterium from one. The source of contamination was found to be contaminated water used during the sclerotherapy sessions. By instituting simple techniques to eliminate this contamination, patients undergoing the remaining 25 EVS sessions were culture negative.