Prospective Study On Bacteremia After Endoscopic Submucosal Dissection For Gastric Mucosa Or Submucosal Lesions

Background:Endoscopic Submucosal Dissection(ESD)is one of the safe and feasible methods to treat early gastrointestinal tumors.Common complications of ESD include hemorrhage,perforation,etc.bacteremia is also one of the complications after ESD.bacteremia may cause serious adverse consequences,including acute peritonitis,meningitis,endocarditis,etc.At present,Whether prophylactic antibiotics should be used after gastric ESD is still controversial.Objective:The purpose of this study is to explore the clinical value of prophylactic antibiotics after gastric ESD.Methods:In this prospective clinical study,from December 1,2018 to December 31,2019,103 patients hospitalized with gastric ESD due to gastric mucosa or submucosal lesions in the Department of Gastroenterology,First Affiliated Hospital of Nanchang University were included.According to the presence or absence of perforation in ESD operation,the patients were divided into perforated group and non-perforated group.The general conditions of patients(age,sex,basic diseases,serum albumin,body mass index,hospitalization time,operation time,exposure time of perforation),lesion related conditions(lesion size,lesion depth,lesion site,postoperative pathological results),observation indexes(white blood cell count,C-reactive protein,procalcitonin,body temperature),blood culture related conditions(culture time,bacterial species,overall incidence rate)and other data were collected.Results:A total of 103 patients were included,including 75 cases of gastric stromal tumor,13 cases of early gastric cancer,15 other cases(lipoma,etc.),32 males(31.1%)and 71 females(68.9%),with an average age of 51.0 years,and there was no statistical difference in preoperative body temperature(T),white blood cell count(WBC),procalcitonin(PCT)and C-reactive protein(CRP)levels between perforationgroup(N=40)and non-perforation group(N=63)(P>0.05).24 hours after ESD,the levels of T,WBC and CRP in perforated group were significantly higher than those in non-perforated group(P<0.05).There was no statistical difference in the incidence of bacteremia between the two groups(P>0.05).In total,6 of 309 blood cultures were cultured with bacteria,including 3 coagulase negative staphylococci.The total incidence of bacteremia in perforation group and non-perforation group was 2.5% and3.2%,respectively.No sepsis observed in any patients.Conclusions:Whether perforation occurs during ESD or not,the incidence of postoperative bacteremia is very low.Therefore,based on this prospective clinical study,the occurrence of perforation during gastric ESD and the use of prophylactic antibiotics after operation may not be necessary.