We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Post-sclerotherapy Bacterial Peritonitis: A Complication of Sclerotherapy or of Variceal Bleeding?
- Authors
Bac, D. J.; De Marie, S.; Siersema; Snobl, J.; Van Buuren, H. R.
- Abstract
To assess the risk of bacterial peritonitis following endoscopic variceal sclerotherapy (EVS), we recorded the incidence of this complication within 2 wk of the procedure in all patients (n = 216) undergoing 1092 sclerotherapy sessions in our hospital during a 5-yr period (1987-1992). The sclerotherapy sessions were separated in prophylactic EVS (without a previous hieeding, n = 172 sessions), elective EVS (following a previous variceal hieeding, n = 720), and emergency EVS (within 24 h of a variceal bleeding, n = 200). During the study period, 60 patients with spontaneous bacterial peritonitis were recorded. In 10 patients, peritonitis was diagnosed within 14 days after EVS. Six patients received emergency EVS and four elective EVS. In seven patients, Gram-negative aerobic and anaerobic microorganisms were cultured from the ascitic fluid, and in three patients cultures were negative; however, an elevated ascitic fluid polymorphonuclear cell count of >0.5 x 109 cells/L was present. The mean period between EVS and the diagnosis of peritonitis was 3.5 days. On average, the patients had been febrile during 2.1 days before the diagnosis was established. None of the patients who had received prophylactic EVS developed peritonitis. The calculated risk to develop peritonitis following elective EVS was 0.5% (4/ 742 sessions) and following emergency EVS 3% (6/200 sessions) (p = 0.019, Fisher's exact test). Gram-negative gut-derived microorganisms were the most common pathogenic bacteria cultured from the ascites, which is different from the microbial flora causing bacteremia after EVS. This suggests that the risk for bacterial peritonitis is determined primarily by factors associated with bleeding, such as shock with increased bowel wall translocation of bacteria. These results indicate that standard antibiotic prophylaxis before EVS is not indicated, but could be considered in patients with liver cirrhosis and ascites receiving emergency EVS.
- Subjects
PERITONITIS; SCLEROTHERAPY; ENDOSCOPIC surgery; NEUTROPHILS; BACTERIAL diseases
- Publication
American Journal of Gastroenterology (Springer Nature), 1994, Vol 89, Issue 6, p859
- ISSN
0002-9270
- Publication type
Article