Impact of Antibiotic Prophylaxis on Infection Rate after Endoscopic Ultrasound Through-the-Needle Biopsy of Pancreatic Cysts: A Propensity Score-Matched Study

Abstract

Background: Despite weak evidence, antibiotic prophylaxis prior to endoscopic ultrasound-guided through-the-needle biopsy (EUS-TTNB) of pancreatic cystic lesions (PCLs) is routinely used in clinical practice. We aim to compare a group of patients treated with antibiotics before EUS-TTNB of PCLs and a group who did not undergo antimicrobial prophylaxis. Methods: Out of 236 patients with pancreatic cystic lesions referred to two high-volume centers between 2016 and 2021, after propensity score matching, two groups were compared: 98 subjects who underwent EUS-TTNB under antibiotic prophylaxis and 49 subjects without prophylaxis. Results: There was no difference in terms of baseline parameters between groups. Final diagnosis was serous cystadenoma in 36.7% of patients in the group not treated with prophylaxis and in 37.7% of patients in the control group, whereas IPMN and mucinous cystadenoma were diagnosed in 3 (6.1%) and 16 (32.6%) versus 6 (6.1%) and 32 (32.6%) patients in the two groups, respectively (p = 0.23). Overall, the adverse event rate was 6.1% in the group not treated with antibiotic prophylaxis and 5.1% in the control group (p = 0.49). Only a single infectious adverse event occurred in each group (p = 0.48). The diagnostic yields were 89.7% and 90.8% in the two groups (p = 0.7), and the diagnostic accuracy rate was 81.6% in both groups (p = 1.0). Conclusions: Prophylactic antibiotics do not seem to influence the risk of infection, and their routine use should be discouraged.

Endoscopic Ultrasound Through-The-Needle Biopsy of Pancreatic Cysts: Toward Procedure Standardization

“…The use of antibiotic prophylaxis with a single IV shot is current practice despite the lack of conclusive evidence [3]. Two recently published studies add more solid evidence about the lack of additional benefit from this prophylaxis after EUS-FNA of cystic lesions, even when TTNB is performed [33, 34].…”

Antibioprophylaxis in endoscopic ultrasound guided fine needle aspiration in pancreatic cysts: A systematic review and meta‐analysis

“…Overall, we identified 318 papers; among them, 302 were excluded as they were obviously irrelevant, reviews papers, case reports, and editorial, and another one study was excluded as it reported infection rate with TTNB. 15 Thus, we left with 15 studies who reported the safety and complications of EUS-FNA as their primary outcomes that were totally accessed and included in the review. Among the 15 studies reviewed, nine studies were single-arm studies reporting the cyst infection rate with ABP, while six studies were double-arm studies reporting infection rate with and without ABP.…”

“…Any disagreement among the studies was solved by a consulting third author (BN). Overall, we identified 318 papers; among them, 302 were excluded as they were obviously irrelevant, reviews papers, case reports, and editorial, and another one study was excluded as it reported infection rate with TTNB 15 . Thus, we left with 15 studies who reported the safety and complications of EUS‐FNA as their primary outcomes that were totally accessed and included in the review.…”