Published online Aug 14, 2017. doi: 10.3748/wjg.v23.i30.5457
Peer-review started: May 28, 2017
First decision: June 23, 2017
Revised: June 27, 2017
Accepted: July 22, 2017
Article in press: July 24, 2017
Published online: August 14, 2017
This is an editorial comment on a recent publication reporting an increased rate of pyogenic liver abscesses (PLAs) after upper gastrointestinal panendoscopy. Its aim is to critically highlight the findings, limitations and potential clinical implications of this study. Issues of the mucosal barrier, the microbial flora, administration of antibiotics and underlying diseases are discussed. The probability of PLAs after endoscopies is not exactly known and the length of the “incubation period” remains unclear, but a possible causality should already suffice to make us think how to avoid them. Especially in patients with risk factors such as diabetes mellitus, end-stage renal disease, liver cirrhosis, biliary tract infection, and malignancies, the potential risk for PLAs should be considered. Unnecessary insufflation during endoscopy (causing mucosal stretching and microscopic tears) as well as mucosal damage (by direct abrasion with the scope) should be avoided in order to limit the invasiveness of the procedure as much as possible. And, in everyday routine, it should be kept in mind that in patients after endoscopy, especially in those with a breach of the mucosal barrier and significant comorbidities, PLAs can potentially develop and require timely administration of antibiotics as well as further diagnostic and therapeutic steps.
Core tip: An increased rate of pyogenic liver abscesses after upper gastrointestinal endoscopy has been reported in a recent publication, leaving clinicians in some kind of predicament. Are we really exposing our endoscopy patients to a considerable danger? In an invited editorial comment on this study, the background, limitations and potential clinical implications of the findings are discussed.