Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography

Abstract

Prophylactic antibiotics reduce bacteriaemia and seem to prevent cholangitis and septicaemia in patients undergoing elective ERCP. In the subgroup of patients with uncomplicated ERCP, the effect of antibiotics may be less evident. Further research is required to determine whether antibiotics can be given during or after an ERCP if it becomes apparent that biliary obstruction cannot be relieved during that procedure.

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

“…In a Cochrane meta-analysis (9 RCTs, 1573 patients), the prophylactic use of antibiotics was shown to prevent cholangitis (relative risk (RR) 0.54, 95% CI 0.33 to 0.91), septicemia (RR 0.35, 95% CI 0.11 to 1.11), bacteriemia (RR 0.50, 95% CI 0.33 to 0.78), and pancreatitis (RR 0.54, 95% CI 0.29 to 1.00). It was concluded that prophylactic antibiotics reduce bacteriemia and seem to prevent cholangitis and septicemia in patients undergoing elective ERCP (87). Our recommendation is in line with the ASGE recommendation to prescribe antibiotic prophylaxis in procedures where drainage achieved at ERCP is incomplete or achieved with difficulty, such as PSC (88).…”

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

“…In a Cochrane meta-analysis (9 RCTs, 1573 patients), the prophylactic use of antibiotics was shown to prevent cholangitis (relative risk (RR) 0.54, 95% CI 0.33 to 0.91), septicemia (RR 0.35, 95% CI 0.11 to 1.11), bacteriemia (RR 0.50, 95% CI 0.33 to 0.78), and pancreatitis (RR 0.54, 95% CI 0.29 to 1.00). It was concluded that prophylactic antibiotics reduce bacteriemia and seem to prevent cholangitis and septicemia in patients undergoing elective ERCP (87). Our recommendation is in line with the ASGE recommendation to prescribe antibiotic prophylaxis in procedures where drainage achieved at ERCP is incomplete or achieved with difficulty, such as PSC (88).…”

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

“…In a Cochrane meta-analysis (9 RCTs, 1573 patients), the prophylactic use of antibiotics was shown to prevent cholangitis (relative risk [RR] 0.54, 95 %CI 0.33 -0.91), septicemia (RR 0.35, 95 %CI 0.11 -1.11), bacteremia (RR 0.50, 95 %CI 0.33 -0.78), and pancreatitis (RR 0.54, 95 %CI 0.29 -1.00). It was concluded that prophylactic antibiotics reduce bacteremia and seem to prevent cholangitis and septicemia in patients undergoing elective ERCP [73]. Our recommendation is in line with the American Society for Gastrointestinal Endoscopy (ASGE) recommendation to prescribe antibiotic prophylaxis in procedures where drainage achieved at ERCP is incomplete or achieved with difficulty, such as in PSC [74].…”

Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel

“…However, the procedure is similar to other biliary interventions like ERCP and PTBD with contrast injection and manipulation done in an obstructed biliary system, resulting in introducing and/or disseminating bacteria. The use of antibiotics was shown to prevent cholangitis, septicaemia, bacteraemia and pancreatitis in ERCP, particularly for obstructed systems 106. Thus, prophylactic antibiotics should be used in a similar manner.…”

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

“…In a Cochrane meta-analysis (9 RCTs, 1573 patients), the prophylactic use of antibiotics was shown to prevent cholangitis (relative risk (RR) 0.54, 95% CI 0.33 to 0.91), septicemia (RR 0.35, 95% CI 0.11 to 1.11), bacteriemia (RR 0.50, 95% CI 0.33 to 0.78), and pancreatitis (RR 0.54, 95% CI 0.29 to 1.00). It was concluded that prophylactic antibiotics reduce bacteriemia and seem to prevent cholangitis and septicemia in patients undergoing elective ERCP (87). Our recommendation is in line with the ASGE recommendation to prescribe antibiotic prophylaxis in procedures where drainage achieved at ERCP is incomplete or achieved with difficulty, such as PSC (88).…”

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

“…In a Cochrane meta-analysis (9 RCTs, 1573 patients), the prophylactic use of antibiotics was shown to prevent cholangitis (relative risk [RR] 0.54, 95 %CI 0.33 -0.91), septicemia (RR 0.35, 95 %CI 0.11 -1.11), bacteremia (RR 0.50, 95 %CI 0.33 -0.78), and pancreatitis (RR 0.54, 95 %CI 0.29 -1.00). It was concluded that prophylactic antibiotics reduce bacteremia and seem to prevent cholangitis and septicemia in patients undergoing elective ERCP [73]. Our recommendation is in line with the American Society for Gastrointestinal Endoscopy (ASGE) recommendation to prescribe antibiotic prophylaxis in procedures where drainage achieved at ERCP is incomplete or achieved with difficulty, such as in PSC [74].…”

Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel

“…However, the procedure is similar to other biliary interventions like ERCP and PTBD with contrast injection and manipulation done in an obstructed biliary system, resulting in introducing and/or disseminating bacteria. The use of antibiotics was shown to prevent cholangitis, septicaemia, bacteraemia and pancreatitis in ERCP, particularly for obstructed systems 106. Thus, prophylactic antibiotics should be used in a similar manner.…”

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

“…In a Cochrane meta-analysis (9 RCTs, 1573 patients), the prophylactic use of antibiotics was shown to prevent cholangitis (relative risk (RR) 0.54, 95% CI 0.33 to 0.91), septicemia (RR 0.35, 95% CI 0.11 to 1.11), bacteriemia (RR 0.50, 95% CI 0.33 to 0.78), and pancreatitis (RR 0.54, 95% CI 0.29 to 1.00). It was concluded that prophylactic antibiotics reduce bacteriemia and seem to prevent cholangitis and septicemia in patients undergoing elective ERCP (87). Our recommendation is in line with the ASGE recommendation to prescribe antibiotic prophylaxis in procedures where drainage achieved at ERCP is incomplete or achieved with difficulty, such as PSC (88).…”

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

“…In a Cochrane meta-analysis (9 RCTs, 1573 patients), the prophylactic use of antibiotics was shown to prevent cholangitis (relative risk [RR] 0.54, 95 %CI 0.33 -0.91), septicemia (RR 0.35, 95 %CI 0.11 -1.11), bacteremia (RR 0.50, 95 %CI 0.33 -0.78), and pancreatitis (RR 0.54, 95 %CI 0.29 -1.00). It was concluded that prophylactic antibiotics reduce bacteremia and seem to prevent cholangitis and septicemia in patients undergoing elective ERCP [73]. Our recommendation is in line with the American Society for Gastrointestinal Endoscopy (ASGE) recommendation to prescribe antibiotic prophylaxis in procedures where drainage achieved at ERCP is incomplete or achieved with difficulty, such as in PSC [74].…”

Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel

“…However, the procedure is similar to other biliary interventions like ERCP and PTBD with contrast injection and manipulation done in an obstructed biliary system, resulting in introducing and/or disseminating bacteria. The use of antibiotics was shown to prevent cholangitis, septicaemia, bacteraemia and pancreatitis in ERCP, particularly for obstructed systems 106. Thus, prophylactic antibiotics should be used in a similar manner.…”