Liver Abscess as a Complication of Esophgeal Balloon Dilation

Abstract

Purpose: Despite the increase use of upper endoscopy, the complication rate has remained low. Infectious complications of EGD include transmission of infection by contaminated endoscopes or ancillary equipment, bacteremia and aspiration pneumonia. Here, we are reporting a liver abscess followed a routine upper endoscopy dilation in patient with gastric bypass. Methods: A 59 year old patient with history of gastric bypass 19 years ago presented with intermittent dysphagia has been going on for the last few months. Her upper endoscopy was remarkable for schatzki ring and gastric pouch contained undigested food. The gastrointestinal anastomosis was patent. The schatzki ring was dilated using CRE balloon 15–18 mm with evidence of breaking the mucosa at 16.5 and 18 mm. Her other past medical history was significant otherwise for thyroid cancer, thyroidectomy 20 years ago, tobacco and ETOH abuse. Patient presented with right upper quadrant pain 2 days after the EGD to outside facility. She was treated symptomatically. Pain returned and patient developed fever and chills. CT scan of the abdomen performed at our facility 2 weeks after the EGD showed left hepatic lobe abscess. US guided drainage grew Candida Albicans, streptococcus Solivarius, and Beta Hemolytic Strep Group B. Esophagogram failed to show any leak or perforation. The abscess resolved with IV antibiotic and percutaneous drainage without the need for surgery. Results: The timing between the onset of her symptoms and the EGD suggest causal relationship. This is most likely related to transient bacteremia secondary to the dilation. Her altered anatomy, gastroparesis and ETOH intake, probably predisposed her for the bacteremia and the immune suppression status. Conclusion: Esophageal dilation has the highest incidence of bacteremia of all gastrointestinal endoscopic procedures, occurring in approximately 45 percent of cases. In spite of this, complications of bacteremia such as endocarditis are rare. The most common reported complication is endocarditis, and less frequently meningitis. Antibiotic prophylaxis is not warranted in most patients undergoing esophageal dilation except for those at high risk. People with immunosupressed status or altered anatomy might need to be considered for prophylaxis.