BACKGROUND: Because the invasive procedure of endoscopic submucosal dissection (ESD) entails a large mucosal defect which is left open, with extensive submucosal exposure to the indigenous bacterial flora, the procedure may have a substantial risk for bacteremia. Our aim was to examine gastric ESD-related bacteremia and endotoxemia in gastric neoplasia patients. METHODS: In patients who underwent ESD for superficial gastric neoplasia, blood cultures and plasma endotoxin measurements were done before, immediately after, and on day 2 after ESD. Clinically manifest infections and inflammatory markers, including C-reactive protein (CRP) and white blood cells, were monitored. RESULTS: Fifty patients (aged 69 ± 8 years; mean ± SD) were enrolled. The diameter of the resected specimens was 38 ± 18 mm and the procedure time of ESD was 66 ± 53 min. Two percent (2/100) of blood cultures after ESD were positive, with findings as follows: Propionibacterium species immediately after ESD, and Enterobacter aerogenes on day 2 after ESD, but no clinically manifest infection was observed. In 30% of the enrolled patients, CRP on day 2 after ESD had increased to levels higher than 1.0 mg/l. Plasma endotoxin levels, immediately after and on day 2 after ESD were correlated with CRP levels on day 2 after ESD. CONCLUSIONS: In spite of the invasive procedure with massive submucosal exposure to the indigenous bacterial flora, gastric ESD has a low risk for bacteremia. Gastric ESD-related endotoxemia may be linked to inflammatory reactions such as those shown by the increase of CRP or fever observed after ESD.
BACKGROUND: Because the invasive procedure of endoscopic submucosal dissection (ESD) entails a large mucosal defect which is left open, with extensive submucosal exposure to the indigenous bacterial flora, the procedure may have a substantial risk for bacteremia. Our aim was to examine gastric ESD-related bacteremia and endotoxemia in gastric neoplasiapatients. METHODS: In patients who underwent ESD for superficial gastric neoplasia, blood cultures and plasma endotoxin measurements were done before, immediately after, and on day 2 after ESD. Clinically manifest infections and inflammatory markers, including C-reactive protein (CRP) and white blood cells, were monitored. RESULTS: Fifty patients (aged 69 ± 8 years; mean ± SD) were enrolled. The diameter of the resected specimens was 38 ± 18 mm and the procedure time of ESD was 66 ± 53 min. Two percent (2/100) of blood cultures after ESD were positive, with findings as follows: Propionibacterium species immediately after ESD, and Enterobacter aerogenes on day 2 after ESD, but no clinically manifest infection was observed. In 30% of the enrolled patients, CRP on day 2 after ESD had increased to levels higher than 1.0 mg/l. Plasma endotoxin levels, immediately after and on day 2 after ESD were correlated with CRP levels on day 2 after ESD. CONCLUSIONS: In spite of the invasive procedure with massive submucosal exposure to the indigenous bacterial flora, gastric ESD has a low risk for bacteremia. Gastric ESD-related endotoxemia may be linked to inflammatory reactions such as those shown by the increase of CRP or fever observed after ESD.
Authors: Subhas Banerjee; Bo Shen; Todd H Baron; Douglas B Nelson; Michelle A Anderson; Brooks D Cash; Jason A Dominitz; S Ian Gan; M Edwyn Harrison; Steven O Ikenberry; Sanjay B Jagannath; David Lichtenstein; Robert D Fanelli; Ken Lee; Trina van Guilder; Leslie E Stewart Journal: Gastrointest Endosc Date: 2008-03-28 Impact factor: 9.427
Authors: S Seewald; T L Ang; S Omar; S Groth; F Dy; Y Zhong; U Seitz; F Thonke; E Yekebas; J Izbicki; N Soehendra Journal: Endoscopy Date: 2006-10 Impact factor: 10.093
Authors: Walter Wilson; Kathryn A Taubert; Michael Gewitz; Peter B Lockhart; Larry M Baddour; Matthew Levison; Ann Bolger; Christopher H Cabell; Masato Takahashi; Robert S Baltimore; Jane W Newburger; Brian L Strom; Lloyd Y Tani; Michael Gerber; Robert O Bonow; Thomas Pallasch; Stanford T Shulman; Anne H Rowley; Jane C Burns; Patricia Ferrieri; Timothy Gardner; David Goff; David T Durack Journal: Circulation Date: 2007-04-19 Impact factor: 29.690
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