Objective: Patients presenting with Streptococcus gallolyticus subsp. gallolyticus (biotype 1) infective endocarditis are at high risk for occult gastrointestinal neoplasia.
Early bowel evaluation reveals occult gastrointestinal neoplasia in a significant
percentage of this patient cohort. We sought to evaluate the availability of gastroenteroscopic
evaluation results after discharge from the cardio-surgical unit.
Methods: Patients with Streptococcus gallolyticus subsp. gallolyticus (biotype 1) infective endocarditis who underwent heart valve surgery between January
2000 and December 2016 were identified from our hospital database. All patients were
discharged to rehabilitation centers, primary cardiology units, or home under primary
care physician’s care. Respective caregivers were required to schedule a timely gastroenteroscopic
evaluation for each patient.
Results: From January 2000 through December 2016, eighteen adults with Streptococcus gallolyticus subsp. gallolyticus (biotype 1) infective endocarditis were identified. Follow-up analysis revealed that
gastroenteroscopic evaluations were obtained only in 8 (50%) of the patients of which
7(87.5%) had occult gastrointestinal adenomas at different stages of development.
Conclusion: The association between Streptococcus gallolyticus subsp. gallolyticus bacteremia and gastrointestinal neoplasia is well established. However, the awareness
among physicians involved in the postsurgical care of this patient cohort remains
insufficient. Omission to follow-up meticulously places these patients at risk of
advanced gastrointestinal neoplasia. We strongly recommend gastroenteroscopy evaluation
of these patients prior to discharge from the cardio-surgical unit. In cases where
this is not feasible, ambulatory gastroenteroscopic evaluation should be pursued in
every single patient.
