Bowel Evaluation after Surgical Treatment of Streptococcus gallolyticus Subsp. Gallolyticus (Biotype 1) Infective Endocarditis: Should We Aim for In-hospital Evaluation

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.