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Shi D, Liu J. Comparing large-volume band ligators and cyanoacrylate injection for gastric variceal eradication: A prospective study. Medicine (Baltimore) 2022; 101:e31939. [PMID: 36401384 PMCID: PMC9678509 DOI: 10.1097/md.0000000000031939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The role of endoscopy in the ligation of gastric varices (GV) remains controversial. This study aimed to evaluate the efficacy of endoscopic band ligation (EBL) using large-volume ligators for the management of non-bleeding GV in patients with cirrhosis. METHODS One hundred fifty-eight patients with non-bleeding GV due to cirrhosis were divided randomly into 2 groups: the EBL group and the endoscopic variceal obturation (EVO) group. The EBL group underwent EBL with large-volume ligators and the EVO group underwent tissue glue injection for the treatment of GV. Follow-up endoscopy was performed 3 to 4 weeks after endoscopic treatment. Patients were followed up for ≥6 months after treatment. Eradication, complication, and recurrence rates were evaluated and compared between groups. RESULTS The type and size of GV were similar in both groups. No significant difference was found in the mean number of treatment sessions or eradication and recurrence rates after 6 months. Ulcer bleeding occurred in 2 EBL patients (2.50%) after ligation, whereas 8 EVO patients (10.25%) experienced bleeding due to glue extrusion. The bleeding rate after endoscopic treatment significantly differed between the groups. In the EVO group, 1 patient developed renal embolism after injection and 2 patients developed sepsis. The prevalence of postoperative fever was significantly higher in the EVO group than in the EBL group. CONCLUSION SUBSECTIONS Large-volume band ligators have similar efficacy to tissue glue for eradicating GV, however, the former is safer. Nevertheless, multicenter studies are needed to further confirm these results.
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Affiliation(s)
- Ding Shi
- Department of Gastroenterology, Ningbo No. 2 Hospital, Ningbo, China
| | - Jianping Liu
- Department of Gastroenterology, Ningbo No. 2 Hospital, Ningbo, China
- * Correspondence: Jianping Liu, Department of Gastroenterology, Ningbo No. 2 Hospital, Ningbo 315010, China (e-mail: )
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Abstract
Acute variceal bleeding is a complication of portal hypertension, usually due to cirrhosis, with high morbidity and mortality. There are 3 scenarios for endoscopic treatment of esophageal varices: prevention of first variceal bleed, treatment of active variceal bleed, and prevention of rebleeding. Patients with cirrhosis should be screened for esophageal varices. Recommended endoscopic therapy for acute variceal bleeding is endoscopic variceal banding. Although banding is the first-choice treatment, sclerotherapy may have a role. Treatment with Sengstaken-Blakemore tube or self-expanding covered metallic esophageal stent can be used for acute variceal bleeding refractory to standard pharmacologic and endoscopic therapy.
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Affiliation(s)
- Marc J Zuckerman
- Division of Gastroenterology and Hepatology, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA.
| | - Sherif Elhanafi
- Division of Gastroenterology and Hepatology, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Antonio Mendoza Ladd
- Division of Gastroenterology and Hepatology, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
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Choi SI, Yoon EL. Two Cases of Fungemia after Endoscopic Variceal Obturation for Gastric Variceal Bleeding. Yonsei Med J 2021; 62:182-186. [PMID: 33527799 PMCID: PMC7859686 DOI: 10.3349/ymj.2021.62.2.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/18/2022] Open
Abstract
Fever is a common complication of endoscopic variceal obturation (EVO) therapy for gastric variceal bleeding. However, fungemia related to EVO therapy has not yet been reported. Herein, we report two cases of post-EVO fungemia in cirrhotic patients who underwent therapeutic EVO for gastric variceal bleeding. Both patients developed sustained high fever after repeated EVO procedures while on prophylactic antibiotic use. In both patients, blood cultures revealed yeast, and they were finally diagnosed with Candida infection. Candida is a common member of the intestinal flora; however, it can cause invasive infection with consequent poor prognosis in cirrhotic patients. The route of Candida invasion is unclear; however, repeated EVO may predispose patients to Candida infection, particularly those who are in the end stage of liver disease and receiving prophylactic antibiotics. Our cases highlight that repeated invasive procedures can increase the risk of fungal infections, and fungemia should be considered in the differential diagnosis of post-EVO fever.
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Affiliation(s)
- Soo In Choi
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Eileen L Yoon
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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4
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Liu C, Ma L, Wang J, Li F, Tseng Y, Luo T, Zeng X, Chen S. Prophylactic use of antibiotics in endoscopic injection of tissue adhesive for the elective treatment of gastric varices: A randomized controlled study. J Gastroenterol Hepatol 2019; 34:1486-1491. [PMID: 31245885 PMCID: PMC6852571 DOI: 10.1111/jgh.14769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/28/2019] [Accepted: 06/20/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tissue adhesive injection is the first-line treatment for gastric varices rebleeding. Available studies are focused on antibiotic usage in emergency endoscopy, while the use of antibiotics in selective endoscopic tissue adhesive treatment remains controversial. METHODS This is a randomized controlled study conducted in a tertiary referral hospital. Consecutive patients were enrolled from February 16, 2016, to November 19, 2016, and blindly randomized into two treatment groups. Patients in the prophylactic group received 2 g of cefotiam during endoscopic injection of tissue adhesive. All the subjects were observed for rebleeding, fever, and changes in laboratory indicators in hospital and post-discharge. RESULT One hundred and seven patients who received endoscopic therapy for gastroesophageal varices were included. Fifty-three patients were allocated to the antibiotic prophylactic group and 54 patients to the on-demand group. The two groups had similar baseline characteristics. The incidence of fever in hospital was 2/53 (3.8%) vs 9/54 (16.7%) (P = 0.028). Perioperative and postoperative clinical events were significantly lower in the antibiotic prophylactic group (5.7% vs 24.1%, P = 0.018; 7.5% vs 20.4%, P = 0.050). Inflammation indices were elevated on the first day after endoscopic therapy; however, no significant difference was observed between the two groups. The cumulative rebleeding free rate within 2 months was lower in the antibiotic prophylactic group (1.9% vs 9.3%, P = 0.100). CONCLUSION Our study illustrated that prophylactic use of antibiotics in selective endoscopic injection of tissue adhesive reduced the incidence of the total clinical events in perioperative period and had a trend towards lower rebleeding in 2 months.
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Affiliation(s)
- Chengfeng Liu
- Department of Gastroenterology and HepatologyZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Lili Ma
- Department of Endoscopy CenterZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Jian Wang
- Department of Gastroenterology and HepatologyZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Feng Li
- Department of Gastroenterology and HepatologyZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Yujen Tseng
- Department of Gastroenterology, Huashan HospitalHuashan Hospital, Fudan UniversityShanghaiChina
| | - Tiancheng Luo
- Department of Gastroenterology and HepatologyZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Xiaoqing Zeng
- Department of Gastroenterology and HepatologyZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Shiyao Chen
- Department of Gastroenterology and Hepatology, Endoscopy Center, Evidence‐based Medicine CenterZhongshan Hospital, Fudan UniversityShanghaiChina
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Abd-Elsalam S, El-Kalla F, Kobtan A, Elhendawy M, Badawi R, Mansour L. Response. Gastrointest Endosc 2018; 87:904-905. [PMID: 29454457 DOI: 10.1016/j.gie.2017.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Sherief Abd-Elsalam
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ferial El-Kalla
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Abdelrahman Kobtan
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Elhendawy
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Rehab Badawi
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Loai Mansour
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt
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Grammatikopoulos T, McKiernan PJ, Dhawan A. Portal hypertension and its management in children. Arch Dis Child 2018; 103:186-191. [PMID: 28814423 DOI: 10.1136/archdischild-2015-310022] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/05/2017] [Accepted: 06/12/2017] [Indexed: 01/03/2023]
Abstract
Portal hypertension (PHT), defined as raised intravascular pressure in the portal system, is a complication of chronic liver disease or liver vascular occlusion. Advances in our ability to diagnose and monitor the condition but also predict the risk of gastrointestinal bleeding have enabled us to optimise the management of children with PHT either at a surveillance or at a postbleeding stage. A consensus among paediatric centres in the classification of varices can be beneficial in streamlining future paediatric studies. New invasive (endoscopic and surgical procedures) and non-invasive (pharmacotherapy) techniques are currently used enabling clinicians to reduce mortality and morbidity in children with PHT.
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Affiliation(s)
- Tassos Grammatikopoulos
- Paediatric Liver, Gastroenterology & Nutrition Centre and MowatLabs, King's College Hospital NHS Foundation Trust, London, UK
| | - Patrick James McKiernan
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Anil Dhawan
- Paediatric Liver, Gastroenterology & Nutrition Centre and MowatLabs, King's College Hospital NHS Foundation Trust, London, UK
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Parbhu SK, Adler DG. Endoscopic management of acute esophageal variceal bleeding. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2017. [DOI: 10.1016/j.tgie.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Zuckerman MJ, Jia Y, Hernandez JA, Kolli VR, Norte A, Amin H, Casner NA, Dwivedi A, Ho H. A Prospective Randomized Study on the Risk of Bacteremia in Banding versus Sclerotherapy of Esophageal Varices. Front Med (Lausanne) 2016; 3:16. [PMID: 27200352 PMCID: PMC4852182 DOI: 10.3389/fmed.2016.00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/11/2016] [Indexed: 01/22/2023] Open
Abstract
Background Esophageal variceal banding may be less likely to cause bacteremia than sclerotherapy. The existing data about the frequency of bacteremia after esophageal variceal banding are conflicting, and few studies include both banding and sclerotherapy. Aims We conducted a prospective randomized controlled trial to compare the frequency of bacteremia after esophageal variceal banding and sclerotherapy. Methods Over a 2-year period, patients with liver disease admitted for upper gastrointestinal bleeding or for outpatient elective variceal therapy were enrolled. New patients were randomized preprocedure to either banding or sclerotherapy, and subsequent sessions utilized the initial procedure. The groups consisted of banding, sclerotherapy, and endoscopy without variceal therapy. Subjects underwent endoscopy by one out of three gastroenterologists. Blood cultures were obtained 5 min before and 30 min after endoscopy to check for bacteremia. Results Postendoscopic blood cultures were positive following 4 out of 139 (2.9%) sessions: 1 sclerotherapy and 3 control sessions. All postendoscopic positive blood cultures were found following emergency sessions (4/92, 4.3%). One pre-endoscopic blood culture was positive in a patient with emergency banding. The rates of positive postendoscopic blood cultures among groups with emergency banding (0/22, 0%), emergency sclerotherapy (1/41, 2.3%), and emergency control (3/29, 10.3%) were not significantly different. Postendoscopic positive blood cultures were not found after elective sessions with either banding or sclerotherapy. Conclusions Postendoscopic bacteremia was infrequent following emergency endoscopy in patients with esophageal variceal bleeding. Bacteremia was not found after esophageal variceal banding, although this was not significantly less frequent than after sclerotherapy. Postendoscopic bacteremia was not associated with elective variceal therapy.
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Affiliation(s)
- Marc J Zuckerman
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Yi Jia
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Jesus A Hernandez
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Venkateswara R Kolli
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Arturo Norte
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Hemal Amin
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Nancy A Casner
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Alok Dwivedi
- Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Hoi Ho
- Division of Infectious Disease, Texas Tech University Health Sciences Center , El Paso, Texas , USA
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9
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Othman MO, Guerrero R, Elhanafi S, Davis B, Hernandez J, Houle J, Mallawaarachchi I, Dwivedi AK, Zuckerman MJ. A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct. Gastrointest Endosc 2016; 83:151-7. [PMID: 26116469 DOI: 10.1016/j.gie.2015.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 05/06/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The frequency of bacteremia during ERCP with cholangioscopy has not been well studied. There are no formal guidelines regarding antibiotic prophylaxis before ERCP with cholangioscopy. The aim was to estimate the frequency of bacteremia and subsequent infectious adverse events after ERCP with cholangioscopy. METHODS This prospective nonrandomized study performed in a single tertiary referral center included adult patients who were undergoing ERCP with cholangioscopic examination of the common bile duct. Blood cultures were drawn from patients before the procedure and 5 and 30 minutes after the procedure. Antibiotics were not given before or after the procedure. Patients were followed up after 24 hours and 1 week after the procedure for infectious adverse events. The primary outcome was bacteremia rate, and secondary outcomes were cholangitis rate and adverse events. RESULTS Fifty-seven patients were enrolled in the study with 60 procedures performed. The first procedure from each patient was considered in the analysis, and thus we included 57 patients with 57 procedures in this study analysis. Postprocedure bacteremia was seen in 5 of 57 procedures (8.8%; 95% confidence interval, 2.9%-19.3%). Four patients were readmitted with cholangitis (7.0%). Bacteremia was more common in patients who had cholangioscopy with biopsy sampling compared with patients who had cholangioscopy without biopsy sampling (P = .011). Cholangitis was significantly more common in patients with bacteremia than in those patients with a negative blood culture (P = .035). CONCLUSION ERCP with cholangioscopy is associated with a bacteremia rate of 8.8% and a cholangitis rate of 7.0%. Preprocedural antibiotics may be considered before cholangioscopy, especially if tissue acquisition with biopsy sampling is expected. ( CLINICAL TRIAL REGISTRATION NUMBER NCT01673269.).
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Affiliation(s)
- Mohamed O Othman
- Gastroenterology and Hepatology Section, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Richard Guerrero
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Sherif Elhanafi
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Brian Davis
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Jesus Hernandez
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Jennifer Houle
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Indika Mallawaarachchi
- Division of Biostatistics & Epidemiology, Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alok Kumar Dwivedi
- Division of Biostatistics & Epidemiology, Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Marc J Zuckerman
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
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Jia Y, Dwivedi A, Elhanafi S, Ortiz A, Othman M, Zuckerman M. Low risk of bacteremia after endoscopic variceal therapy for esophageal varices: a systematic review and meta-analysis. Endosc Int Open 2015; 3:E409-17. [PMID: 26528494 PMCID: PMC4612236 DOI: 10.1055/s-0034-1392552] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 05/07/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS 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.
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Affiliation(s)
- Yi Jia
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alok Dwivedi
- Division of Biostatistics & Epidemiology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Sherif Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Arleen Ortiz
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Mohamed Othman
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Marc Zuckerman
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA,Corresponding author Marc J. Zuckerman, MD Division of GastroenterologyTexas Tech University Health Sciences Center4800 Alberta AvenueEl PasoTexas 79905USA+1-915-545-6634
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11
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Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev 2013; 26:231-54. [PMID: 23554415 DOI: 10.1128/cmr.00085-12] [Citation(s) in RCA: 291] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Flexible endoscopy is a widely used diagnostic and therapeutic procedure. Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections. Accurate reprocessing of flexible endoscopes involves cleaning and high-level disinfection followed by rinsing and drying before storage. Most contemporary flexible endoscopes cannot be heat sterilized and are designed with multiple channels, which are difficult to clean and disinfect. The ability of bacteria to form biofilms on the inner channel surfaces can contribute to failure of the decontamination process. Implementation of microbiological surveillance of endoscope reprocessing is appropriate to detect early colonization and biofilm formation in the endoscope and to prevent contamination and infection in patients after endoscopic procedures. This review presents an overview of the infections and cross-contaminations related to flexible gastrointestinal endoscopy and bronchoscopy and illustrates the impact of biofilm on endoscope reprocessing and postendoscopic infection.
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Joo K, Hyun IY, Baek JH, Chung MH, Lee JS. Detection of an Infected N-butyl-2-cyanoacrylate Plug by F-18 FDG PET/CT Scan in a Patient Who Received Endoscopic Intervention for Gastric Variceal Bleeding. Infect Chemother 2013; 45:230-3. [PMID: 24265972 PMCID: PMC3780960 DOI: 10.3947/ic.2013.45.2.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/15/2013] [Accepted: 05/20/2013] [Indexed: 11/24/2022] Open
Abstract
Injection of N-butyl-2-cyanoacrylate has been used successfully for treatment of gastric variceal bleeding. Bacteremia after injection of N-butyl-2-cyanoacrylate is well known, however, the method for diagnosis of infected endovascular injected material has remained uncertain. This is the first case reporting use of F-18 FDG PET/CT in detection of the source of infection after control of endoscopic bleeding with N-butyl-2-cyanoacrylate.
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Affiliation(s)
- Kowoon Joo
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
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13
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Pathophysiologie der Leberkrankheiten. PÄDIATRISCHE GASTROENTEROLOGIE, HEPATOLOGIE UND ERNÄHRUNG 2013. [PMCID: PMC7498791 DOI: 10.1007/978-3-642-24710-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In der sinusoidalen Membran beginnt die Gallebildung. Rezeptoren und Transporter erleichtern die Aufnahme und den Eintritt von Gallensäuren, Bilirubin, Fettsäuren und anderen Gallekomponenten in die Leberzelle. Diese enthält Rezeptoren für Glykoproteine, Asialoglykoprotein, Immunglobulin A (Ig A), vasoaktives intestinales Peptid (VIP), Insulin, Glukagon und „epidermal growth factor“ (EGF). Ein primär aktiver Transport erfolgt durch die Na+-K+-ATPase, die einen Ionengradienten an der Zellmembran aufbaut und innerhalb der Zelle ein negatives elektrisches Potenzial erzeugt (wodurch die Diffusion erleichtert wird). Dieser Ionengradient ermöglicht die Arbeit anderer Carrier gegen das Konzentrationsgefälle, z. B. von NTCP (Natrium-Taurocholsäure-Kotransport-Polypeptid), das auch für zahlreiche Medikamente, Östrogene und zyklische Oligopeptide spezifisch ist. Transporter für organische Anionen (OATP1) und anorganische Ionen wurden ebenfalls nachgewiesen.
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Affiliation(s)
- Bruce A Runyon
- Liver Service, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
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15
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Chen SY, Tsai CL, Lin CH, Lee CC, Chiang WC, Wang JL, Ma MHM, Chen SC, Chen WJ, Chang SC. Impact of liver cirrhosis on mortality in patients with community-acquired bacteremia. Diagn Microbiol Infect Dis 2009; 64:124-30. [PMID: 19304439 DOI: 10.1016/j.diagmicrobio.2009.01.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 09/30/2008] [Accepted: 01/21/2009] [Indexed: 02/06/2023]
Abstract
Few studies have analyzed the impact of liver cirrhosis, a clinically significant comorbid medical condition, on the mortality of patients with community-acquired bacteremia. We conducted an observational study of 839 consecutive community-acquired bacteremia patients who were hospitalized through the emergency department (ED). We compared the 30-day mortality of bacteremia patients with and without liver cirrhosis using Cox proportional hazards regression. The probability of survival at day 30 was significantly different for the cirrhotic and noncirrhotic groups (53% versus 82%, respectively; P < 0.001 by the log-rank test). Multivariate analysis indicated that liver cirrhosis was associated with an increased risk of short-term mortality (hazard ratio, 2.0; 95% confidence interval, 1.1-3.5), as well as age, higher comorbidity index, and markers obtained from clinical presentation at ED. In conclusion, in addition to the effects from other prognostic factors, liver cirrhosis has a significant impact on the mortality of patients with community-acquired bacteremia.
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Affiliation(s)
- Shey-Ying Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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Levy MJ, Norton ID, Clain JE, Enders FB, Gleeson F, Limburg PJ, Nelson H, Rajan E, Topazian MD, Wang KK, Wiersema MJ, Wilson WR. Prospective study of bacteremia and complications With EUS FNA of rectal and perirectal lesions. Clin Gastroenterol Hepatol 2007; 5:684-9. [PMID: 17544995 DOI: 10.1016/j.cgh.2007.02.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Recent studies showed that endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is a low-risk procedure for causing bacteremia and infectious complications when sampling solid lesions of the upper gastrointestinal (GI) tract. As a result, antibiotics are not recommended for prophylaxis against endocarditis. Our aim was to prospectively evaluate the risk of bacteremia and other infectious complications in patients undergoing EUS FNA of lower GI tract lesions. METHODS Patients referred for EUS FNA of lower GI tract lesions were considered for enrollment. Patients were excluded if there was an indication for preprocedure antibiotic administration based on American Society for Gastrointestinal Endoscopy guidelines, had taken antibiotics within the prior 7 days, or if they had a cystic lesion. Blood cultures were obtained immediately before the procedure, after flexible sigmoidoscopy/radial EUS, and 15 minutes after EUS FNA. RESULTS One hundred patients underwent a total of 471 FNAs (mean, 4.7 FNAs/patient; range, 1-10 FNAs/patient). Blood cultures were positive in 6 patients. Cultures from 4 patients (4.0%, 95% confidence interval, 1.6%-9.8%) grew coagulase-negative Staphylococcus (n = 2), Peptostreptococcus stomatis (n = 1), or Moraxella (n = 1), which were considered contaminants. Two patients (2.0%, 95% confidence interval, 0.6%-7%) developed bacteremia: Bacteroides fragilis (n = 1) and Gemella morbillorum (n = 1). No signs or symptoms of infection developed in any patient. CONCLUSIONS EUS FNA of solid lesions in the lower GI tract should be considered a low-risk procedure for infectious complications that does not warrant prophylactic administration of antibiotics for the prevention of bacterial endocarditis.
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Affiliation(s)
- Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic Foundation, Rochester, Minnesota 55905, USA.
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Weickert U, Vetter S, Burkhardt U, Eickhoff A, Bühl A, Riemann JF. Bacteremia after diagnostic conventional laparoscopy and minilaparoscopy: a prospective study in 100 patients. J Clin Gastroenterol 2006; 40:701-4. [PMID: 16940882 DOI: 10.1097/00004836-200609000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND/GOALS Diagnostic laparoscopy under sedoanalgesia is a valuable tool in the work-up of liver diseases and is helpful as a staging procedure. The rate of bacteremia caused by this procedure is unknown, in particular when performed as minilaparoscopy. STUDY A 100 consecutive patients having undergone diagnostic laparoscopy carried out either conventionally (group I, n=50) or as minilaparoscopy (group II, n=50) were prospectively enrolled in this study. Blood cultures were drawn before and within 5 minutes after the procedure. Risk factors for bacteremia were evaluated. RESULTS Bacterial growth occurred in 4 blood cultures drawn immediately after laparoscopy. No patient developed fever or other signs of infection in the follow-up. Risk factors predisposing to bacteremia could not be identified. CONCLUSIONS Conventional diagnostic laparoscopy under sedoanalgesia and minilaparoscopy are associated with a low rate of bacteremia as in diagnostic upper endoscopy.
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Affiliation(s)
- Uwe Weickert
- Department of Internal Medicine C, Ludwigshafen Hospital, Academic Hospital of the University of Mainz, Germany.
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Horstkotte D, Follath F, Gutschik E, Lengyel M, Oto A, Pavie A, Soler-Soler J, Thiene G, von Graevenitz A. [Guidelines on prevention, diagnosis and treatment of infective endocarditis. Executive summary]. Rev Esp Cardiol 2004; 57:952-62. [PMID: 15469793 DOI: 10.1016/s0300-8932(04)77224-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wahl P, Lammer F, Conen D, Schlumpf R, Bock A. Septic complications after injection of N-butyl-2-cyanoacrylate: report of two cases and review. Gastrointest Endosc 2004; 59:911-6. [PMID: 15173814 DOI: 10.1016/s0016-5107(04)00341-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Peter Wahl
- Department of Surgery, Kantonsspital, Aarau, Switzerland
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20
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Coumaros D. [Gastrointestinal hemorrhage. Prevention of recurrent bleeding: modalities of endoscopic treatments]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2004; 28 Spec No 2:B83-97. [PMID: 15150500 DOI: 10.1016/s0399-8320(04)95243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Dimitri Coumaros
- Service d'Hépato-Gastroentérologie, Hôpitaux Universitaires, F 67091 Strasbourg Cedex
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Maulaz EB, de Mattos AA, Pereira-Lima J, Dietz J. Bacteremia in cirrhotic patients submitted to endoscopic band ligation of esophageal varices. ARQUIVOS DE GASTROENTEROLOGIA 2004; 40:166-72. [PMID: 15029392 DOI: 10.1590/s0004-28032003000300006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endoscopic procedures can develop bacteremia. Patients with chronic liver disease are more predisposed to undergo bacteremia and infections because they are immunocompromised. AIMS The purpose of this study was to determine the incidence of bacteremia in cirrhotics submitted to endoscopic variceal ligation. METHODS Three groups of 40 patients each were studied. One group was made up of patients with cirrhosis who were submitted to ligation, a second group was composed of cirrhotics who underwent esophagogastroduodenoscopy only, and a third group was composed of patients without liver disease who underwent esophagogastroduodenoscopy. Blood was sampled from all patients for culture, both in aerobic and in anaerobic mediums, immediately before endoscopy and at 5 and 30 minutes after its completion. RESULTS Blood culture was positive in 6 samples. In 4 of these, the bacteria (Staphylococcus hominis hominis, Staphylococcus auricularis, Acinetobacter lwoffii, and coagulase-negative staphylococcus) were isolated before the endoscopic procedure and thus were considered as contamination. In the ligation group, a streptococcus of the viridans group was isolated 5 minutes after the procedure, and in the cirrhosis without ligation group, a Staphylococcus epidermidis was isolated at 30 minutes. None of the patients showed clinical evidence of infection. CONCLUSIONS The bacteremia incidence in cirrhotic patients submitted to variceal ligation was 2.5%, showing no difference from the control groups.
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Affiliation(s)
- Eduardo Balzano Maulaz
- Santa Casa Hospital, Departamento of Gastroenterologia, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Brazil
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Janssen J, König K, Knop-Hammad V, Johanns W, Greiner L. Frequency of bacteremia after linear EUS of the upper GI tract with and without FNA. Gastrointest Endosc 2004; 59:339-44. [PMID: 14997128 DOI: 10.1016/s0016-5107(03)02707-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Few data are available concerning the frequency of bacteremia after diagnostic EUS or EUS-guided FNA. This study was undertaken to provide these data and to determine whether present guidelines for prophylactic administration of antibiotics to prevent endocarditis during upper endoscopy are applicable to EUS and EUS-guided FNA. METHODS A total of 100 patients who were to undergo diagnostic EUS of the upper-GI tract and 50 who were to have upper-GI EUS-guided FNA were enrolled in this prospective study. Blood cultures were obtained before and within 5 minutes after the conclusion of the procedure. In case of bacterial growth, patients were observed for at least 3 days for signs of infection. RESULTS After diagnostic EUS, significant bacteremia was found in two patients with esophageal carcinoma (2%: 95% CI[0%, 4.8%]) and after EUS-guided FNA in two patients (4%: 95% CI[0%, 9.6%]). The difference was not statistically significant. None of these patients developed clinical signs of infection. Risk factors predisposing to bacteremia could not be identified. CONCLUSION The frequency of bacteremia after EUS, with and without FNA, is within the range of that for diagnostic upper endoscopy. Therefore, the same recommendations for prophylactic administration of antibiotics to prevent endocarditis may be applied in patients undergoing EUS and EUS-guided FNA. The role of esophageal cancer as a predisposing factor to EUS-associated infection remains uncertain.
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Affiliation(s)
- Jan Janssen
- Department of Medicine 2 and the Institute for Microbiology and Immunology, HELIOS Klinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
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Levy MJ, Norton ID, Wiersema MJ, Schwartz DA, Clain JE, Vazquez-Sequeiros E, Wilson WR, Zinsmeister AR, Jondal ML. Prospective risk assessment of bacteremia and other infectious complications in patients undergoing EUS-guided FNA. Gastrointest Endosc 2003; 57:672-8. [PMID: 12709695 DOI: 10.1067/mge.2003.204] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are few data regarding the risk of bacteremia with EUS-guided FNA. This study prospectively evaluated the frequency of bacteremia and other infectious complications after EUS-guided FNA. METHODS Patients referred for EUS-guided FNA of the upper GI tract lesions were considered for enrollment. Patients were excluded if there was an indication for preprocedure administration of antibiotics based on ASGE guidelines, had taken antibiotics within the prior 7 days, or if they had a pancreatic cystic lesion. Blood cultures were obtained immediately before the procedure, after routine endoscopy/radial EUS, and 15 minutes after EUS-guided FNA. RESULTS Fifty-two patients underwent EUS-guided FNA at 74 sites (mean 1.4 sites/patient) totaling 266 passes of the fine needle (mean 5.1 FNA/patient). Coagulase negative Staphylococcus was grown in cultures from 3 patients (5.8%; 95% CI [1%, 15%]) and was considered a contaminant. Three patients (5.8%; 95% CI [1%, 15%]) developed bacteremia: Streptococcus viridans (n = 2), unidentified gram-negative bacillus (n = 1). No signs or symptoms of infection developed in any patient. CONCLUSION EUS-guided FNA of solid lesions in the upper GI tract should be considered a low-risk procedure for infectious complications that does not warrant prophylactic administration of antibiotics for prevention of bacterial endocarditis.
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Affiliation(s)
- Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic Foundation, Rochester, Minnesota 55905, USA
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Affiliation(s)
- Douglas B Nelson
- Gastroenterology, Minneapolis VA Medical Center, Minnesota 55417, USA
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Faigel DO, Eisen GM, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, Jacobson BC, Johanson JF, Leighton JA, Mallery JS, Raddawi HM, Vargo JJ, Waring JP, Fanelli RD, Wheeler-Harbough J. Preparation of patients for GI endoscopy. Gastrointest Endosc 2003; 57:446-50. [PMID: 12665751 DOI: 10.1016/s0016-5107(03)80006-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Nelson DB. Infection control during gastrointestinal endoscopy. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 2003; 141:159-67. [PMID: 12624597 DOI: 10.1067/mlc.2003.24] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Infection-control issues during gastrointestinal endoscopy, which are becoming increasingly important, can generally be divided into three major areas: (1) infectious complications resulting from a patient's own microbial flora (autologous), (2) infections transmitted from patient to patient by way of the endoscope (exogenous), and (3) infections transmitted between the patient and the health-care provider. The mean frequency of postprocedure bacteremia ranges from 0.5% for flexible sigmoidoscopy to 2.2% for colonoscopy, 4.2% for esophagogastroduodenoscopy, 8.9% for variceal ligation, 11% for endoscopic retrograde cholangiopancreatography, 15.4% for variceal sclerotherapy, and 22.8% for esophageal dilation. Although postprocedure bacteremia is not uncommon, it seldom results in infectious complications. Exogenous infections transmitted during endoscopy, which are extremely rare, generally result from failure to follow accepted guidelines for the cleaning and disinfection of gastrointestinal endoscopes, underscoring the importance of meticulous attention to endoscope reprocessing. Finally, although the risk of patient-staff transmission of infection is also rare, standard infection-control recommendations are important in protecting both patients and health-care providers.
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Affiliation(s)
- Douglas B Nelson
- Department of Gastroenterology, Minneapolis Veterans Affairs Medical Center, University of Minnesota, 55417, USA.
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Chen WC, Hou MC, Lin HC, Yu KW, Lee FY, Chang FY, Lee SD. Bacteremia after endoscopic injection of N-butyl-2-cyanoacrylate for gastric variceal bleeding. Gastrointest Endosc 2001; 54:214-8. [PMID: 11474393 DOI: 10.1067/mge.2001.116566] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cyanoacrylate may form a barrier that prevents bacterial invasion when used in tissue. Because cyanoacrylate polymerizes within seconds on contact with aqueous media, it is used worldwide to arrest gastric variceal bleeding. The aim of this study was to determine the frequency of bacteremia after endoscopic cyanoacrylate injection for gastric variceal bleeding. METHODS Patients with cirrhosis who underwent endoscopic cyanoacrylate injection for gastric variceal bleeding were included. Patients with cirrhosis who underwent upper endoscopy for nonvariceal upper GI bleeding were recruited as controls. Patients with infection before endoscopy were excluded. Blood was cultured in both groups. Injection needles and endoscope accessory channels were cultured in the cyanoacrylate injection group. RESULTS More patients injected with cyanoacrylate had positive blood cultures in comparison with the control group (15/47 vs. 1/47, p < 0.0001). In the cyanoacrylate injection group, the volume of blood transfused and Child-Pugh score were factors associated with the occurrence of bacteremia. Most episodes of bacteremia were transient, except for 1 patient who died of sepsis. Most of the microorganisms cultured from blood samples were identical to those cultured from injection needles (65%) and accessory channels (90%). CONCLUSIONS Endoscopic cyanoacrylate injection for gastric varices does not limit the spread of bacteria. The endoscope accessory channel was the major source of bacteria. Most episodes of bacteremia were transient and uneventful.
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Affiliation(s)
- W C Chen
- Division of Gastroenterology, Department of Medicine, and Department of Pathology and Laboratory Medicine, Taipei-Veterans General Hospital, and from National Yang-Ming University School of Medicine, Taipei, Taiwan
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Abstract
Among patients with acute gastrointestinal bleeding, older age is associated with an increased rate of comorbidity, greater medication use, and atypical clinical presentations. The aging of the population makes the evaluation and management of gastrointestinal bleeding in the elderly a special and increasingly common clinical challenge. The unique features and common causes of upper and lower gastrointestinal bleeding in the elderly are reviewed. Important management issues considered include hemodynamic resuscitation; anticoagulation; and medical, surgical, and endoscopic therapy.
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Affiliation(s)
- J J Farrell
- Harvard Medical School, Boston, Massachusetts, USA
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Türler A, Wolff M, Dorlars D, Hirner A. Embolic and septic complications after sclerotherapy of fundic varices with cyanoacrylate. Gastrointest Endosc 2001; 53:228-30. [PMID: 11174302 DOI: 10.1067/mge.2001.111561] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- A Türler
- Department of Surgery, Faculty of Medicine, Rheinische Friedrich-Wilhelms-University Bonn, Klinikum Kassel, Germany
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31
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Franchi D, Bahrani A, Ober JF, Edmond MB. Preventing nosocomial infections from gastrointestinal endoscopy. Curr Gastroenterol Rep 2000; 2:294-8. [PMID: 10981026 DOI: 10.1007/s11894-000-0021-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Gastrointestinal procedures have been associated with a wide range of infectious complications, including bacterial endocarditis. Although the rate of bacteremia from the patient's own flora is quite high after some procedures, only a few cases of endocarditis caused by gastrointestinal instrumentation have been reported. Because of the severity of the illness, however, antibiotic prophylaxis has been recommended for patients who are categorized as high risk for some procedures. Bacteremia and other infections, such as colitis, may also originate from a contaminated endoscope. To prevent such an occurrence, high-level disinfection has been recommended for gastrointestinal endoscopes. High-level disinfection includes manual cleaning of the endoscope, flushing of internal channels with a liquid chemical sterilant, and thorough rinsing and drying of internal lumens.
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Affiliation(s)
- D Franchi
- Department of Internal Medicine, Eastern Virginia School of Medicine, 824 Fairfax Avenue, Norfolk, VA 23507-1912, USA.
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Lin OS, Wu SS, Chen YY, Soon MS. Bacterial peritonitis after elective endoscopic variceal ligation: a prospective study. Am J Gastroenterol 2000; 95:214-7. [PMID: 10638586 DOI: 10.1111/j.1572-0241.2000.01687.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Endoscopic variceal ligation is becoming the therapy of choice for esophageal varices, replacing endoscopic variceal sclerotherapy. The latter is associated with a 5-53% incidence of port-procedural bacteremia and a 0.5-3% incidence of peritonitis, whereas the former carries a 3-6% risk of bacteremia. However, the incidence of peritonitis after variceal ligation has not been well studied. This prospective study is designed to investigate the risk of developing bacteremia and bacterial peritonitis after elective endoscopic variceal ligation. METHODS Sixty-seven patients with esophageal varices and ascites secondary to liver cirrhosis underwent elective endoscopic variceal ligation. Before the procedure, ascitic fluid was drawn under ultrasound guidance and sent for cell counts, Gram stain, and cultures. Two to 4 days afterward, a repeat ascitic fluid sample was sent for the same studies whether or not the patient had symptoms or signs suggestive of infection. Blood cultures were drawn both immediately before and after the endoscopic ligation procedure. RESULTS Of 67 subjects, 11 developed asymptomatic bacteremia with Gram-positive commensals. However, none of them progressed to peritonitis. Two patients who did not have bacteremia developed mild febrile peritonitis with Escherichia coli and were successfully treated with oral antibiotics. No other infectious complications were noted. CONCLUSIONS There is a significant risk of asymptomatic bacteremia and bacterial peritonitis after elective variceal ligation. The peritonitis does not seem to be related to the bacteremia, as patients who had bacteremia did not develop peritonitis and vice versa. In addition, the involved organisms were quite different. Unlike the bacteremia, postligation peritonitis may be a consequence of severe liver cirrhosis rather than the procedure itself. The clinical significance of postligation bacteremia is doubtful. With regard to peritonitis, in our opinion the use of prophylactic antibiotics should be reserved for patients with Child's C class cirrhosis, a recent history of variceal bleeding, a past history of bacterial peritonitis, or a comorbid immunosuppressive condition.
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Affiliation(s)
- O S Lin
- Division of Gastroenterology, ChangHua Christian Medical Center, Taiwan
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Strauss E, Ribeiro MF, Albano A, Honain NZ, Maffei RA, Caly WR. Long-term follow up of a randomized, controlled trial on prophylactic sclerotherapy of small oesophageal varices in liver cirrhosis. J Gastroenterol Hepatol 1999; 14:225-30. [PMID: 10197490 DOI: 10.1046/j.1440-1746.1999.01799.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND In order to evaluate the prophylactic impact of sclerotherapy of small varices in patients with cirrhosis and no endoscopic signs suggesting risk of haemorrhage, a randomized clinical trial was performed. METHODS Seventy-one hospitalized patients met the inclusion criteria of diagnosis of cirrhosis with no previous bleeding and small varices. Due to exclusion criteria of: gastroduodenal ulcers (n = 5), diverticulosis (n = 1), hepatic insufficiency (n = 10), hepatocellular carcinoma (n = 4), death before randomization (n = 6), age over 70 (n = 1) and denial of consent to participate in the study (n = 1), 43 patients could be randomized, 21 for sclerotherapy and 22 for the control group. Two patients (one in each group) were lost to follow up, and another patient, although not lost, refused sclerotherapy after randomization. Ethanolamine oleate was used as the sclerosing agent. All patients were followed up for a mean time of 60 months, initially every 2 months for the first 2 years and clinical and endoscopic controls were performed each 6-12 months thereafter. RESULTS AND CONCLUSIONS During the first 2 years clinical assessment showed that there were five bleedings in the sclerotherapy group and none in the control group, but mortality was similar in both groups. Long-term follow up continued to show a higher prevalence of bleeding in the sclerotherapy group but that mortality was not different from the control group.
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Affiliation(s)
- E Strauss
- Clinic of Gastroenterology, Hospital Heliópolis, São Paulo, Brazil.
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Nagamine N, Kaneko Y, Kumakura Y, Ogawa Y, Ido K, Kimura K. Occurrence of pyogenic meningitis during the course of endoscopic variceal ligation therapy. Gastrointest Endosc 1999; 49:110-3. [PMID: 9869735 DOI: 10.1016/s0016-5107(99)70457-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- N Nagamine
- Department of Gastroenterology, Jichi Medical School, Yamanashi-ken, Japan
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da Silveira Rohr MR, Siqueira ES, Brant CQ, Morais M, Libera ED, Castro RR, Ferrari AP. Prospective study of bacteremia rate after elastic band ligation and sclerotherapy of esophageal varices in patients with hepatosplenic schistosomiasis. Gastrointest Endosc 1997; 46:321-3. [PMID: 9351034 DOI: 10.1016/s0016-5107(97)70118-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Esophageal band ligation is considered to be as efficient as endoscopic sclerotherapy, with a lower complication rate, including bacteremia. There are few studies comparing the two methods. The aim of this study was to compare the incidence of bacteremia after both treatments in patients with portal hypertension secondary to schistosomiasis. METHODS Endoscopic sclerotherapy and band ligation were performed using standard techniques. Blood samples were obtained 5 and 30 minutes after endoscopic band ligation or sclerotherapy and cultured for aerobic and anaerobic organisms. RESULTS In the sclerotherapy group 2 of 43 (4.6%) blood cultures were positive (Peptostreptococcus sp and Streptococcus mitis). A similar result was obtained in the band ligation group: 2 of 35 (5.7%) had positive cultures, both with Staphylococcus aureus. CONCLUSIONS There is no difference in the frequency of bacteremia after treatment of esophageal varices with endoscopic sclerotherapy or endoscopic band ligation in patients with portal hypertension secondary to schistosomiasis.
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Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, Gewitz MH, Shulman ST, Nouri S, Newburger JW, Hutto C, Pallasch TJ, Gage TW, Levison ME, Peter G, Zuccaro G. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. Circulation 1997; 96:358-66. [PMID: 9236458 DOI: 10.1161/01.cir.96.1.358] [Citation(s) in RCA: 288] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To update recommendations issued by the American Heart Association last published in 1990 for the prevention of bacterial endocarditis in individuals at risk for this disease. PARTICIPANTS An ad hoc writing group appointed by the American Heart Association for their expertise in endocarditis and treatment with liaison members representing the American Dental Association, the Infectious Diseases Society of America, the American Academy of Pediatrics, and the American Society for Gastrointestinal Endoscopy. EVIDENCE The recommendations in this article reflect analyses of relevant literature regarding procedure-related endocarditis, in vitro susceptibility data of pathogens causing endocarditis, results of prophylactic studies in animal models of endocarditis, and retrospective analyses of human endocarditis cases in terms of antibiotic prophylaxis usage patterns and apparent prophylaxis failures. MEDLINE database searches from 1936 through 1996 were done using the root words endocarditis, bacteremia, and antibiotic prophylaxis. Recommendations in this document fall into evidence level III of the US Preventive Services Task Force categories of evidence. CONSENSUS PROCESS The recommendations were formulated by the writing group after specific therapeutic regimens were discussed. The consensus statement was subsequently reviewed by outside experts not affiliated with the writing group and by the Science Advisory and Coordinating Committee of the American Heart Association. These guidelines are meant to aid practitioners but are not intended as the standard of care or as a substitute for clinical judgment. CONCLUSIONS Major changes in the updated recommendations include the following: (1) emphasis that most cases of endocarditis are not attributable to an invasive procedure; (2) cardiac conditions are stratified into high-, moderate-, and negligible-risk categories based on potential outcome if endocarditis develops; (3) procedures that may cause bacteremia and for which prophylaxis is recommended are more clearly specified; (4) an algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse; (5) for oral or dental procedures the initial amoxicillin dose is reduced to 2 g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered; and (6) for gastrointestinal or genitourinary procedures, the prophylactic regimens have been simplified. These changes were instituted to more clearly define when prophylaxis is or is not recommended, improve practitioner and patient compliance, reduce cost and potential gastrointestinal adverse effects, and approach more uniform worldwide recommendations.
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Wong A, Rosenstein AH, Rutherford RE, James SP. Bacterial endocarditis following endoscopic variceal sclerotherapy. J Clin Gastroenterol 1997; 24:90-1. [PMID: 9077724 DOI: 10.1097/00004836-199703000-00009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report the case of a patient in whom bacterial endocarditis developed on a native valve after variceal sclerotherapy. We are concerned about the discrepant recommendations for antibiotic prophylaxis in the literature and consider that our report, which we take to be the first, suggests reasons for prophylactic antibiotic treatment in selected patients undergoing sclerotherapy.
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Affiliation(s)
- A Wong
- Division of Gastroenterology, University of Maryland Medical Center, Baltimore 21201-1595, U.S.A
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Deacon JM, Pagliaro AJ, Zelicof SB, Horowitz HW. Prophylactic use of antibiotics for procedures after total joint replacement. J Bone Joint Surg Am 1996; 78:1755-70. [PMID: 8934495 DOI: 10.2106/00004623-199611000-00020] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J M Deacon
- Department of Orthopaedic Surgery, New York Medical College, Valhalla 10595, USA
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Bac DJ. Spontaneous bacterial peritonitis: an indication for liver transplantation? SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1996; 218:38-42. [PMID: 8865449 DOI: 10.3109/00365529609094729] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with cirrhosis and ascites with a poor prognosis. The survival pattern and the reasons for not performing a liver transplantation after an episode of SBP were analysed. METHODS A retrospective analysis during the period 1987-1992 in a tertiary referral and liver transplantation centre. RESULTS Sixty episodes of SBP were diagnosed in 52 patients with ascites. Thirty-two percent of the patients died within 30 days and 78% within 1 year. Forty patients who survived less than 1 year did not receive a liver transplantation for the following reasons: death within 30 days (n = 12), age above 65 years (n = 10), medical contraindications (n = 6), active alcohol abuse (n = 6), refusal of transplantation (n = 2), death while being analysed for, or awaiting transplantation (n = 4). Two patients had an auxiliary liver transplantation but died postoperatively. CONCLUSION SBP is a serious complication in patients with cirrhosis and ascites, with a high first-year mortality and a high recurrence rate. Although long-term survival after an episode of SBP is possible, liver transplantation should be considered for the patients with a progressive liver disease after a first episode of SBP.
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Affiliation(s)
- D J Bac
- Dept. of Gastroenterology and Hepatology, University Hospital Rotterdam-Dijkzigt, The Netherlands
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Abstract
This is one of a series of statements discussing the practice of gastrointestinal endoscopy in common clinical situations. It is intended to aid endoscopists in determining the appropriate use of antibiotic prophylaxis for patients undergoing gastrointestinal endoscopic procedures. Guidelines for the appropriate practice of endoscopy are based on a critical review of the available data and expert consensus. Controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance from these recommendations. Recommendations on prophylaxis against infective endocarditis were developed in conjunction with the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease of the Council of Cardiovascular Disease in the Young of the American Heart Association.
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Bacteremia and bacterascites after endoscopic sclerotherapy for bleeding esophageal varices and prevention by intravenous vefotaxime: A randomized trial. Gastrointest Endosc 1994. [DOI: 10.1016/s0016-5107(94)70109-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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45
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A prospective randomized trial comparing somatostatin and sclerotherapy in the treatment of acute variceal bleeding. Hepatology 1994. [DOI: 10.1002/hep.1840200216] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Blaise M, Pateron D, Trinchet JC, Levacher S, Beaugrand M, Pourriat JL. Systemic antibiotic therapy prevents bacterial infection in cirrhotic patients with gastrointestinal hemorrhage. Hepatology 1994. [PMID: 8020902 DOI: 10.1002/hep.1840200107] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This randomized prospective study was aimed at assessing the efficiency of a systemic antibiotic therapy for the prevention of bacterial infections in cirrhotic patients with gastrointestinal hemorrhage by ruptured esophageal varices. For 15 mo, all patients hospitalized with no infection on admission, were included in the study. Starting on admission day, patients in group A received ofloxacin (400 mg/day) for 10 days, first intravenously then orally. They also received an intravenous bolus of amoxicillin plus clavulanic acid (1 g) before each endoscopy performed during hemorrhage. Patients in group B received antibiotic therapy only in cases of established or suspected infection. Chest X-ray, blood culture, urine culture and sputum and ascitic fluid culture were performed every day for 7 days, then every other day for the next 7 days. A bronchial sampling was performed with the Wimberley technique on patients with endotracheal intubation. Ninety-one patients (55 men, 54 +/- 11 years, 78% Child Pugh class C) were included in the study (46 in group A, 45 in group B). Group A showed a lower incidence of bacterial infections than group B (20% vs. 66%; p < 0.001). Breakdown of positive bacteriological sampling was as follows: blood (6 vs. 17), ascites (3 vs. 7), lungs (2 vs. 18), urine (1 vs. 10). The 2-wk mortality rate was 24% in group A and 35% in group B.
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Affiliation(s)
- M Blaise
- Département d'Anesthésie et de Réanimation, Université Paris XIII, Hôpital Jean Verdier, Bondy, France
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Grimaud JC. [Antibiotic prophylaxis in digestive endoscopy]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1994; 13:S169-72. [PMID: 7778806 DOI: 10.1016/s0750-7658(05)81794-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The increasing use of endoscopy in diseases of the digestive tract has been associated with an increase in complications related to is technique. Because of this, various authors have recommended the administration of prophylactic antibiotics in an attempt to avoid infectious complications. This attitude has however been largely empirical, without a real assessment of the benefits and disadvantages. Although no prospective study has shown any clear benefit, it is generally accepted that prophylactic antibiotics should be given systematically whenever a digestive endoscopy is to be performed in a patient with a cardiac valvular disease or a history of bacterial endocarditis. Apart from these situations, prophylactic antibiotics may be indicated for sclerotherapy of actively bleeding oesophageal varices and prior to colonoscopy in immunodepressed patients or in those with an inflammatory disease of the colon.
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Affiliation(s)
- J C Grimaud
- Département d'Anesthésie-Réanimation, CHU Nord, Chemin des Bourrely, Marseille
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Affiliation(s)
- P D King
- Department of Medicine, University of Missouri School of Medicine, Columbia
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