A COMPARISON OF THE INCIDENCE OF TRANSIENT BACTEREMIA AND INFECTIOUS SEQUELAE AFTER SCLEROTHERAPY AND RUBBER BAND LIGATION OF BLEEDING ESOPHAGEAL-VARICES

A comparison of the incidence of transient bacteremia and infectious s equelae in patients undergoing sclerotherapy and those undergoing vari ceal ligation has not yet been reported. Fifty patients admitted with acute esophageal variceal bleeding were treated with sclerotherapy bet ween July 1990 and July 1991. Fifty-five patients were treated with ba nding ligation between July 1991 and July 1992. Blood cultures were ta ken before and 5 minutes, 30 minutes, and 24 hours after treatment to compare the incidence of transient bacteremia in each group. The Incid ence of infectious sequelae during hospitalization was also compared. Transient bacteremia occurred in 17.2% of the sclerotherapy group and in 3.3% of the ligation group (p < 0.03). Infectious sequelae occurred in 18% of the sclerotherapy group and 1.8% of the ligation group (p < 0.01). Apart from bacteremia, the most frequently encountered infecti ous sequela was spontaneous bacterial peritonitis. Both transient bact eremia and infectious sequelae are more likely to develop when liver d isease is severe. Two patients in the sclerotherapy group but hone in the ligation group died of infectious sequelae. The incidence of trans ient bacteremia and infectious complications after sclerotherapy for a cute variceal bleeding is about 5 to 10 times greater than that after variceal ligation. Inasmuch as it is equally effective and entails few er infectious complications, variceal ligation is preferable to sclero therapy for patients with acute variceal bleeding. Further randomized trials are needed.