Prophylactic antibiotics in endoscopic retrograde cholangiopancreatography with peroral cholangioscopy

Aims Single-operator peroral cholangioscopy (SOC) has gained increasing attention in modern biliary and pancreatic therapy and diagnosis. This procedure has shown higher rates of infectious complications than conventional endoscopic retrograde cholangiopancreatography (ERCP); therefore, many guidelines recommend prophylactic antibiotics (AP). We aimed to study whether AP affects postprocedural infectious or overall adverse events (AE) in ERCP with SOC.

Methods We retrospectively extracted data from the Swedish Registry for Gallstone Surgery and ERCP (GallRiks). Of the 124,921 extracted ERCP procedures performed between 2008 and 2021, 2,321 were performed with SOC and represented the study population. The exclusion criteria were incomplete 30-day follow-up and ongoing antibiotic use. Postprocedural infectious complications and overall adverse events at the were the main outcomes [1].

Results AP was administered to 1,843 patients (79.4%). In this group, 3.5% of the patients had infectious complications compared to 3.8% in the non-AP group (P=.74). The overall AE rates were 14.7% and 17.0% in the AP and non-AP groups, respectively (P=.21). The incidence of cholangitis was identical between the groups (3.1%). Both infectious complications (OR 0.92, 95% CI 0.54-1.58) and AE (OR 0.86, 95% CI 0.65-1.13) remained unaffected by AP administration ([Fig. 1]).

Conclusions ERCP with SOC shows a high level of postprocedural infectious complications. However, we were unable to find any differences in complication rates with respect to AP administration.

Fig. 1  

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2023

• 1 Subhash A, Buxbaum JL, Tabibian JH.. Peroral cholangioscopy: Update on the state-of-the-art. World J Gastrointest Endosc 2022; 14: 63-76