Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Cysts With and Without Antibiotic Prophylaxis: A Retrospective Analysis of Infectious Complications

Rivera, Ramon E.; Ray, Arnab; Zacharia, George Sarin

doi:10.14309/00000434-201010001-00130

Cited by 3 publications

(6 citation statements)

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“…The rate of infectious complications following EUS-guided puncture of cystic lesions is low [11,12]. There are no systematic reviews or RCTs comparing antibiotics with no antibiotics before EUS-guided puncture of cystic lesions although one study compared two regimens of antibiotics [13], and two retrospective cohort studies [14,15] focused exclusively on pancreatic cystic lesions. The study by Kwok and colleagues [13], in which 117 patients were screened over an 11-month period, lacked statistical significance however, since only 22 % of screened patients could be enrolled.…”

Section: Domainsmentioning

confidence: 99%

Performance measures for ERCP and endoscopic ultrasound: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Domagk¹,

Oppong

Aabakken

et al. 2018

Endoscopy

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The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). We recommend that endoscopy services across Europe adopt the following seven key and one minor performance measures for EUS and ERCP, for measurement and evaluation in daily practice at center and endoscopist level: 1 Adequate antibiotic prophylaxis before ERCP (key performance measure, at least 90 %); 2 Antibiotic prophylaxis before EUS-guided puncture of cystic lesions (key performance measure, at least 95 %); 3 Bile duct cannulation rate (key performance measure, at least 90 %); 4 Tissue sampling during EUS (key performance measure, at least 85 %); 5 Appropriate stent placement in patients with biliary obstruction below the hilum (key performance measure, at least 95 %); 6 Bile duct stone extraction (key performance measure, at least 90 %); 7 Post-ERCP pancreatitis (key performance measure, less than 10 %). 8 Adequate documentation of EUS landmarks (minor performance measure, at least 90 %).This present list of quality performance measures for ERCP and EUS recommended by ESGE should not be considered to be exhaustive: it might be extended in future to address further clinical and scientific issues.

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Section: Domainsmentioning

confidence: 99%

Performance measures for ERCP and endoscopic ultrasound: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Domagk¹,

Oppong

Aabakken

et al. 2018

Endoscopy

View full text Add to dashboard Cite

show abstract

“…The rate of infectious complications following EUS‐guided puncture of cystic lesions is low 11 , 12 . There are no systematic reviews or RCTs comparing antibiotics with no antibiotics before EUS‐guided puncture of cystic lesions, although one study compared two regimens of antibiotics, 13 and two retrospective cohort studies 14 , 15 focused exclusively on pancreatic cystic lesions. However, the study by Kwok and colleagues, 13 in which 117 patients were screened over an 11‐month period, lacked statistical significance since only 22% of screened patients could be enrolled.…”

Section: Domain: Pre‐proceduresmentioning

confidence: 99%

Performance measures for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

et al. 2018

View full text Add to dashboard Cite

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a short list of key performance measures for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). We recommend that endoscopy services across Europe adopt the following seven key and one minor performance measures for EUS and ERCP, for measurement and evaluation in daily practice at centre and endoscopist level: 1 Adequate antibiotic prophylaxis before ERCP (key performance measure, at least 90%); 2 antibiotic prophylaxis before EUS-guided puncture of cystic lesions (key performance measure, at least 95%); 3 bile duct cannulation rate (key performance measure, at least 90%); 4 tissue sampling during EUS (key performance measure, at least 85%); 5 appropriate stent placement in patients with biliary obstruction below the hilum (key performance measure, at least 95%); 6 bile duct stone extraction /home/ueg (key performance measure, at least 90%); 7 post-ERCP pancreatitis (key performance measure, less than 10%); and 8 adequate documentation of EUS landmarks (minor performance measure, at least 90%).This present list of quality performance measures for ERCP and EUS recommended by the ESGE should not be considered to be exhaustive; it might be extended in future to address further clinical and scientific issues.

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“…One study was just available in abstract form and was excluded. 15 After reading the full text of potentially eligible studies, 10 more were excluded because either they did not use antibiotics as an intervention, infection was not included as an outcome, or they had a different patient population. [23][24][25][26][27][28][29][30][31][32] Six studies met the inclusion criteria, including a total of 1683 of patients who underwent EUS-FNA of PCLs.…”

Section: Results Of the Searchmentioning

confidence: 99%

“…[6][7][8] The use of antibiotic prophylaxis to reduce the incidence of infection has come into question in recent years after several studies have demonstrated the safety of the procedure and suggested the lack of additional benefit with prophylactic antibiotics as well as the fact that previous reports may represent an overestimation of infectious complications. 2,[9][10][11][12][13][14][15] Given the use of antibiotics is not exempt of adverse effects and entails extra economic costs, the abandonment or modification of this practice may streamline EUS-FNA without jeopardizing patients' safety.…”

mentioning

confidence: 99%

“…Because of the limited evidence available regarding PCL infection after EUS-FNA, the current guidelines from the American Society for Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy provide a weak recommendation for the routine use of antibiotic prophylaxis based on long-standing clinical practice 6–8 . The use of antibiotic prophylaxis to reduce the incidence of infection has come into question in recent years after several studies have demonstrated the safety of the procedure and suggested the lack of additional benefit with prophylactic antibiotics as well as the fact that previous reports may represent an overestimation of infectious complications 2,9–15 . Given the use of antibiotics is not exempt of adverse effects and entails extra economic costs, the abandonment or modification of this practice may streamline EUS-FNA without jeopardizing patients' safety.…”

mentioning

confidence: 99%

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Prophylactic Antibiotics Do Not Prevent Infectious Complications of Endoscopic Ultrasound Fine-Needle Aspiration of Pancreatic Cysts

et al. 2021

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Despite limited evidence, endoscopic societies recommend routine use of antibiotic prophylaxis for endoscopic ultrasound fine-needle aspiration of pancreatic cystic lesions. Recent studies suggest lack of benefit in this setting. Our objective is to conduct a systematic review and meta-analysis to assess the efficacy of antibiotics in prevention of infectious complications after ultrasound fine-needle aspiration of pancreatic cystic lesions. A bibliographic search of digital dissertation databases was performed from inception until March 2020. Randomized controlled trials, cohort, and case-control studies that compared prophylactic antibiotics with placebo or no therapy were included in the analysis. The primary outcome was the development of cyst infections. Secondary outcomes were incidence of fever; procedural complications such as bile leak, pancreatitis, or bleeding; and medication-related adverse events. Six studies with a total of 1683 patients were included. The overall incidence of cyst infections was 0.53%. For the primary outcome, there was no significant difference between the 2 groups (odds ratio, 0.54; 95% confidence interval, 0.16-1.82; P = 0.32). No significant difference was noted regarding other complications like fever, pancreatitis, or bile leak. In conclusion, the rate of infectious complications is very low, and antibiotic prophylaxis does not seem to confer any additional benefit in their prevention.

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Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Cysts With and Without Antibiotic Prophylaxis: A Retrospective Analysis of Infectious Complications

Cited by 3 publications

References 0 publications

Performance measures for ERCP and endoscopic ultrasound: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Performance measures for ERCP and endoscopic ultrasound: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Performance measures for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Prophylactic Antibiotics Do Not Prevent Infectious Complications of Endoscopic Ultrasound Fine-Needle Aspiration of Pancreatic Cysts

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