Bacteremia and Injection Sclerotherapy

Abstract

The incidence of bacteremia following injection sclerotherapy for esophageal varices has been a subject of interest since its resurrection in the early 1980s. Multiple invasions of large venous channels through a needle contaminated with salivary microflora might be expected to be associated with a high frequency of bacteremia, especially in cirrhotic patients with "compromised" immune system. Injection of saliva into peripheral veins has been shown to produce fever and polymicrobial bacteremia.¹In this issue of theArchives, Low and colleagues²studied 38 patients subjected to 104 sessions of sclerotherapy and compared blood cultures obtained before and after the procedure. Only 4.3% of the postsclerotherapy blood cultures yielded bacteria. My colleagues and I³previously showed that the incidence of bacteremia following sclerotherapy (5%) is not higher than after routine diagnostic endoscopy (1.8% to 8%).^4-6However, other investigators have reported a higher frequency of bacteremia^7,8and attributed their findings to the length