Which endoscopic procedure is associated with the highest risk of bacteremia?

The procedure associated with the highest risk of bacteremia is esophageal stricture dilation. This is particularly important to note because this procedure involves the mechanical dilation of a narrowed area of the esophagus, which can cause disruption to the mucosal barrier. When the mucosa is damaged, bacteria from the gastrointestinal tract can enter the bloodstream, leading to bacteremia.

In contrast, polypectomy, while it does carry some risk of bleeding and perforation, typically has a lower incidence of bacteremia because it usually involves removing polyps that are less likely to compromise the mucosal barrier significantly.

Endoscopic retrograde cholangiopancreatography (ERCP) can also pose a risk for bacteremia due to the manipulation of the biliary tree, but it is generally considered lower than that of esophageal stricture dilation, particularly in patients with intact mucosal barriers.

Percutaneous endoscopic gastrostomy (PEG) placement involves creating an opening directly into the stomach and also carries some risk; however, the risk of bacteremia is notably less than with esophageal stricture dilation primarily due to the difference in anatomical exposure and the nature of procedures.

Thus, when comparing these endoscopic procedures, esophageal stricture dilation stands out as