Bacteremia after endoscopic injection of N-butyl-2-cyanoacrylate for gastric variceal bleeding

Background: Cyanoacrylate may form a barrier that prevents bacterial invasi on when used in tissue. Because cyanoacrylate polymerizes within seconds on contact with aqueous media, it is used worldwide to arrest gastric varicea l bleeding. The aim of this study was to determine the frequency of bactere mia after endoscopic cyanoacrylate injection for gastric variceal bleeding. Methods: Patients with cirrhosis who underwent endoscopic cyanoacrylate inj ection for gastric variceal bleeding were included. Patients with cirrhosis who underwent upper endoscopy for nonvariceal upper GI bleeding were recru ited as controls. Patients with infection before endoscopy were excluded. B lood was cultured in both groups. Injection needles and endoscope accessory channels were cultured in the cyanoacrylate injection group. Results: More patients injected with cyanoacrylate had positive blood cultu res in comparison with the control group (15/47 vs. 1/47, p<0.0001). In the cyanoacrylate injection group, the volume of blood transfused and Child-Pu gh score were factors associated with the occurrence of bacteremia. Most ep isodes of bacteremia were transient, except for 1 patient who died of sepsi s. Most of the microorganisms cultured from blood samples were identical to those cultured from injection needles (65%) and accessory channels (90%). Conclusions: Endoscopic cyanoacrylate injection for gastric varices does no t limit the spread of bacteria. The endoscope accessory channel was the maj or source of bacteria. Most episodes of bacteremia were transient and uneve ntful.