AUTHOR=Zuckerman Marc J. , Jia Yi , Hernandez Jesus A. , Kolli Venkateswara R. , Norte Arturo , Amin Hemal , Casner Nancy A. , Dwivedi Alok , Ho Hoi 

TITLE=A Prospective Randomized Study on the Risk of Bacteremia in Banding versus Sclerotherapy of Esophageal Varices

JOURNAL=Frontiers in Medicine

VOLUME=Volume 3 - 2016

YEAR=2016

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2016.00016

DOI=10.3389/fmed.2016.00016

ISSN=2296-858X

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 two year period, patients with liver disease admitted for upper gastrointestinal bleeding or for outpatient elective variceal therapy were enrolled. New patients were randomized pre-procedure to either banding or sclerotherapy and subsequent sessions utilized the initial procedure. Groups consisted of banding, sclerotherapy and endoscopy without variceal therapy. Subjects underwent endoscopy by 1 of 3 gastroenterologists.  Blood cultures were obtained before, 5 and 30 minutes after endoscopy to check for bacteremia.
Results: Post-endoscopic blood cultures were positive following 4 of 139 (2.9%) sessions: 1 sclerotherapy and 3 control sessions.  All post-endoscopic 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 post-endoscopic 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.  Post-endoscopic positive blood cultures were not found after elective sessions with either banding or sclerotherapy. 
Conclusions:  Post-endoscopic 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.  Post-endoscopic bacteremia was not associated with elective variceal therapy.