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Low risk of bacteremia after endoscopic variceal therapy for esophageal varices: a systematic review and meta-analysis.

Jia Y, Dwivedi A, Elhanafi S, Ortiz A, Othman M, Zuckerman M - Endosc Int Open (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.

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.

No MeSH data available.


Related in: MedlinePlus

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Mentions: We also compared the incidence of bacteremia according to whether the setting was either an emergency or an elective procedure irrespective of whether they were EVS or EVL studies (Fig. 4 a – c). A total of six studies had emergency EVS or EVL (two with both EVS and EVL) with a frequency of bacteremia of 16 % (95 %CI: 5 – 27 %) and a total of 16 studies had elective EVS or EVL (four with both EVS and EVL) with a frequency of bacteremia of 12 % (95 %CI: 7 – 16 %) (Fig. 4 a, Table 2 b). When EVS or EVL were performed as elective procedures, the risk of bacteremia after these procedures was 6 % lower compared with emergency procedures. The pooled estimate from within studies comparisons showed that elective procedures have a 71 % lower risk of bacteremia compared with emergency procedures and the difference was statistically significant (P = 0.006), while there was a 79 % lower risk of bacteremia during elective procedures compared with emergency procedures within EVS studies, and again the difference was statistically significant (P = 0.002). In contrast, within EVL studies, elective procedures had a 21 % higher risk of bacteremia compared to emergency procedures but the difference was not statistically significant (P = 0.850).


Low risk of bacteremia after endoscopic variceal therapy for esophageal varices: a systematic review and meta-analysis.

Jia Y, Dwivedi A, Elhanafi S, Ortiz A, Othman M, Zuckerman M - Endosc Int Open (2015)

© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612236&req=5

Mentions: We also compared the incidence of bacteremia according to whether the setting was either an emergency or an elective procedure irrespective of whether they were EVS or EVL studies (Fig. 4 a – c). A total of six studies had emergency EVS or EVL (two with both EVS and EVL) with a frequency of bacteremia of 16 % (95 %CI: 5 – 27 %) and a total of 16 studies had elective EVS or EVL (four with both EVS and EVL) with a frequency of bacteremia of 12 % (95 %CI: 7 – 16 %) (Fig. 4 a, Table 2 b). When EVS or EVL were performed as elective procedures, the risk of bacteremia after these procedures was 6 % lower compared with emergency procedures. The pooled estimate from within studies comparisons showed that elective procedures have a 71 % lower risk of bacteremia compared with emergency procedures and the difference was statistically significant (P = 0.006), while there was a 79 % lower risk of bacteremia during elective procedures compared with emergency procedures within EVS studies, and again the difference was statistically significant (P = 0.002). In contrast, within EVL studies, elective procedures had a 21 % higher risk of bacteremia compared to emergency procedures but the difference was not statistically significant (P = 0.850).

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.

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.

No MeSH data available.


Related in: MedlinePlus