Do Gastrointestinal Endoscopic Procedures Cause Endocarditis?
The rate of endocarditis depends on the incidence and intensity of bacteremia and the organisms causing bacteremia. Bacteria vary in their capacity to colonize damaged heart valves. A review of endoscopic literature produced no evidence to implicate gastrointestinal procedures as a major precipitator of bacterial endocarditis. A survey of 123 endoscopy units in the United States revealed only four poorly documented cases of endocarditis, and a single, unconvincing case was found in the British medical literature.(8,9) It should be noted that most of the reviewed cases of endocarditis were reported after the advent of gastrointestinal endoscopy, but no evidence of an increase in the disease was offered.(10,11) The phenomenon of transient bacteremia in human beings has been recognized for many years (Table 1). Hoffman and associates(12) detected bacteremia in 4 percent of their patients five minutes after rectal examination was performed. All isolates were anaerobic and contained in the
