Recent upper gastrointestinal panendoscopy increases the risk of pyogenic liver abscess

Table 1 Demographic features and comorbidities of pyogenic liver abscess cases and controls n (%)

Demographic and clinical characteristics	Cases(n = 2135)	Controls(n = 10675)	Total(n = 12810)	P value
Age, yr
< 20	31 (1.5)	164 (1.5)	195	0.991
20-44	391 (18.3)	1952 (18.3)	2343
45-64	883 (41.4)	4423 (41.4)	5306
65-74	454 (21.3)	2229 (20.9)	2683
75+	376 (17.6)	1907 (17.9)	2283
mean ± SD	58.8 ± 16.5	58.8 ± 16.5	58.8 ± 16.5	0.991
Gender
Female	854 (40.0)	4270 (40.0)	5124	1.000
Male	1281 (60.0)	6405 (60.0)	7686
Diabetes
With	206 (9.7)	253 (2.4)	459	< 0.001
Without	1929 (90.4)	10422 (97.6)	12351
ESRD
With	46 (2.2)	73 (0.7)	119	< 0.001
Without	2089 (97.9)	10602 (99.3)	12691
BTI
With	249 (11.7)	99 (0.9)	348	< 0.001
Without	1886 (88.3)	10576 (99.1)	12462
Liver cirrhosis
With	146 (6.8)	97 (0.9)	243	< 0.001
Without	1989 (93.2)	10578 (99.1)	12567
GI malignancy
With	62 (2.9)	80 (0.8)	142	< 0.001
Without	2073 (97.1)	10595 (99.3)	12668
Appendicitis
With	10 (0.47)	9 (0.08)	19	< 0.001
Without	2125 (99.53)	10666 (99.92)	12791
Diverticulitis
With	12 (0.56)	11 (0.1)	23	< 0.001
Without	2123 (99.44)	10664 (99.9)

ESRD: End-stage renal disease; BTI: Biliary tract infection; GI: Gastrointestinal.

Table 2 Outpatient visits and examination of pyogenic liver abscess cases and controls n (%)

Demographic and clinical characteristics	Cases(n = 2135)	Controls(n = 10675)	Total(n = 12810)	P value
Frequency of OPD visits
< 1	119 (5.6)	2781 (26.1)	2900	< 0.001
1-2	243 (11.4)	1989 (18.6)	2232
3-7	774 (36.3)	3403 (31.9)	4177
≥ 8	999 (46.8)	2502 (23.4)	3501
Frequency of abdominal ultrasound
0	1692 (79.3)	10329 (96.8)	12021	< 0.001
1	358 (16.8)	321 (3.0)	679
≥ 2	85 (4.0)	25 (0.2)	110
Abdominal ultrasound
with	443 (20.8)	346 (3.2)	789	< 0.001
without	1692 (79.3)	10329 (96.8)	12021
ERCP-related procedures
with	107 (5.0)	9 (0.1)	116	< 0.001
without	2028 (95.0)	10666 (99.9)	12694
Upper GI panendoscopy
with	172 (8.1)	131 (1.2)	303	< 0.001
without	1963 (91.9)	10544 (98.8)	12507
Lower GI endoscopy
with	36 (1.7)	53 (0.5)	89	< 0.001
without	2099 (98.3)	10622 (99.5)	12721
Upper or lower GI endoscopy
with	189 (8.9)	171 (1.6)	360	< 0.001
without	1946 (91.2)	10504 (98.4)	12450
Upper GI panendoscopy
upper GI only1	150 (7.0)	130 (1.2)	280	< 0.001
upper GI with ERCP-related procedures	22 (1.0)	1 (0.0)	23
ERCP without upper GI	85 (4.0)	8 (0.1)	93
None2	1878 (88.0)	10536 (98.7)	12414
Lower GI endoscopy
lower GI only1	34 (1.6)	53 (0.5)	87	< 0.001
lower GI with ERCP-related procedures	2 (0.1)	0 (0.0)	2
ERCP without lower GI	105 (4.9)	9 (0.1)	114
None2	1994 (93.4)	10613 (99.4)	12607
Upper or lower GI endoscopy
upper or lower GI only1	166 (7.8)	170 (1.6)	336	< 0.001
upper or lower GI with ERCP-related procedures	23 (1.1)	1 (0.0)	24
ERCP without upper or lower GI	84 (3.9)	8 (0.1)	92
None2	1862 (87.2)	10496 (98.3)	12450

¹Only means patients who received GI endoscopy only and didn’t receive ERCP-related procedures within the previous 90 d;

²None means patients who did not receive GI endoscopy (upper or lower) and ERCP-related procedures within the previous 90 d. ERCP: Endoscopic retrograde cholangiopancreatography; GI: Gastrointestinal; OPD: Outpatient department.

Table 3 Risk of pyogenic liver abscess related to comorbidities and examination n (%)

		aOR	95%CI	P value
Diabetes	With vs without	4.92	1.78-13.61	0.002
ESRD	With vs without	3.98	1.45-10.91	0.007
BTI	With vs without	2.68	2.11-3.40	< 0.001
Liver cirrhosis	With vs without	2.19	1.39-3.46	< 0.001
GI malignancy	With vs without	5.68	4.23-7.64	< 0.001
Appendicitis	With vs without	3.16	2.27-4.41	< 0.001
Diverticulitis	With vs without	1.64	1.01-2.64	0.044
Frequency of OPD visits	1-2 vs < 1	2.65	2.10-3.34	< 0.001
	3-7 vs < 1	4.75	3.86-5.85	< 0.001
	8+ vs < 1	6.72	5.43-8.32	< 0.001
Frequency of Ultrasound	≥ 2 vs 0	3.26	2.69-3.95	< 0.001
	1 vs 0	5.69	3.35-9.66	< 0.001
ERCP-related procedures	With vs without	27.04	11.65-62.72	< 0.001
UGI panendoscopy	With vs without	2.75	2.05-3.69	< 0.001
LGI Endoscopy	With vs without	1.07	0.62-1.86	0.803

aOR: Adjusted odds ratio; ESRD: End-stage renal disease; ERCP: Endoscopic retrograde cholangiopancreatography; BTI: Biliary tract infection; GI: Gastrointestinal tract; UGI: Upper gastrointestinal tract; LGI: Lower gastrointestinal tract.

Table 4 Risks of pyogenic liver abscess related to site and invasiveness of the digestive endoscopy performed n (%)

	Cases (n = 2135)	Controls (n = 10675)	Total	aOR1	95%CI	P value
Upper GI panendoscopy
Without invasive procedure2	130 (6.09)	98 (0.92)	228	Ref.
With invasive procedure	42 (1.97)	33 (0.31)	75	0.91	0.47-1.77	0.787
None3	1963 (91.94)	10544 (98.77)	12507	0.35	0.26-0.49	< 0.001
Lower GI endoscopy
Without invasive procedure2	24 (1.12)	38 (0.36)	62	Ref.
With invasive procedure	12 (0.56)	15 (0.14)	27	0.97	0.32-2.96	0.958
None3	2099 (98.31)	10622 (99.5)	12721	0.66	0.35-1.23	0.193
Upper or Lower GI endoscopy
Without invasive procedure2	138 (6.46)	124 (1.16)	262	Ref.
With invasive procedure	51 (2.39)	47 (0.44)	98	0.87	0.49-1.54	0.624
None3	1946 (91.15)	10504 (98.4)	12450	0.40	0.29-0.54	< 0.001

¹Adjusted OR was adjusted for history of appendicitis, diverticulitis, diabetes, end-stage renal disease, biliary tract infection, liver cirrhosis, GI malignancies, frequency of OPD visits, frequency of ultrasound examination, and ERCP-related procedures;

²Invasive procedures include biopsy, polypectomy, hemostasis and foreign body removal;

³None means patients who didn't receive upper or lower GI endoscopy. aOR: Adjusted odds ratio; GI: Gastrointestinal tract.