A 61-year-old man with a 6-month history of recurrent hematochezia was admitted to
our hospital for the management of symptomatic anemia. Upon admission, his hemoglobin
level was 60 g/L. Esophagogastroduodenoscopy and colonoscopy were performed but did
not reveal the cause of his anemia. Subsequently, single-balloon enteroscopy (SBE)
was conducted, which identified an actively bleeding angioectasia in the distal jejunum,
approximately 300 cm from the incisors ([Fig. 1 ]
a , [Video 1 ]). Hemostasis was achieved using argon plasma coagulation and hemoclip placement
at the bleeding site ([Fig. 1 ]
b, c ). The SBE procedure time was approximately 13 min. Two days post-SBE, the patient
developed a fever, peaking at 39°C, along with leukocytosis (white blood cell count:
21 × 109 /L). A computed tomography (CT) scan of the chest and abdomen did not reveal any source
of infection.
Fig. 1 Single balloon enteroscopy (SBE) was performed to evaluate the cause of anemia in
a 61-year-old ma. a SBE showed an active bleeding angioectasia in the distal jejunum. b Hemostasis was achieved using argon plasma coagulation. c Wound closure after hemostasis using endoclips. d Peripheral venous blood culture revealed growth of Staphylococcus epidermidis .
Single balloon enteroscopy showing an active bleeding angioectasia in the distal jejunum
in a 61-year-old man with anemia.Video 1
Blood cultures grew Staphylococcus epidermidis in three consecutive samples ([Fig. 1 ]
d ). The patient was treated with an initial intravenous dose of tigecycline at 100
mg, followed by 50 mg every 12 h. He became afebrile 2 days after starting antibiotics.
At the 3-month follow-up, the patient remained afebrile with no recurrence of bacteremia.
SBE is commonly performed for both diagnostic and therapeutic interventions in the
small intestine [1 ]. Despite disinfection and processing of endoscopes, device-associated infections
can still occur. Notably, an overtube is used during SBE, which is placed on the endoscope
in a non-sterile environment. Inflation of the balloon used to advance the enteroscope
can compress the intestinal wall, and prolonged balloon inflation (> 10 min) may cause
intestinal wall hypoxia, potentially disrupting the mucosal barrier and increasing
the risk of bacterial translocation, which can result in bacteremia [1 ]
[2 ]
[3 ]. Additionally, mucosal injury is frequently encountered during SBE, further facilitating
bacterial translocation [4 ].
The incidence of S. epidermidis infections has risen with the increased use of medical
instrumentation. Our patient had no cutaneous lesions or evidence of accompanying
gastrointestinal or respiratory infections. Therefore, we attributed the S. epidermidis
bacteremia to the introduction of the bacteria into the digestive tract during the
SBE procedure, followed by translocation through the damaged intestinal mucosa.
Given the increased use of balloon-assisted enteroscopy, our case highlights the importance
of being aware of the potential for enteroscopy-associated bacteremia. Early recognition
of this complication can facilitate timely initiation and discontinuation of antimicrobial
therapy.
Endoscopy_UCTN_Code_CPL_1AI_2AD
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