Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2022; 14(11): 718-730
Published online Nov 16, 2022. doi: 10.4253/wjge.v14.i11.718
Antibiotic prophylaxis to prevent complications in endoscopic retrograde cholangiopancreatography: A systematic review and meta-analysis of randomized controlled trials
Maria Fernanda Shinin Merchan, Diogo Turiani Hourneaux de Moura, Guilherme Henrique Peixoto de Oliveira, Igor Mendonça Proença, Epifanio Silvino do Monte Junior, Edson Ide, Caroline Moll, Sergio A Sánchez-Luna, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
Maria Fernanda Shinin Merchan, Diogo Turiani Hourneaux de Moura, Guilherme Henrique Peixoto de Oliveira, Igor Mendonça Proença, Epifanio Silvino do Monte Junior, Edson Ide, Caroline Moll, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
Sergio A Sánchez-Luna, Department of Internal Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35233, United States
Author contributions: Merchan MFS contributed to acquisition of data, analysis, interpretation of data, drafting the article, revising the article, and final approval; de Moura DTH, de Oliveira GHP, Proença IM, Monte ES, Ide E, and Moll CF contributed to analysis and interpretation of data and revising the article; Sánchez-Luna SA contributed to interpretation of data, drafting the article, revising the article, and final approval; Bernardo WM contributed to analysis of data, interpretation of data, drafting the article, revising the article, and final approval; de Moura EGH contributed to analysis and interpretation of data, drafting the article, revising the article, and final approval.
Conflict-of-interest statement: Diogo Turiani Hourneaux de Moura: BariaTek – Advisory Board Member (Consulting fees); Sergio A Sánchez-Luna: Recipient of the 2021 American Society for Gastrointestinal Endoscopy (ASGE) Endoscopic Training Award by the ASGE and Fujifilm; Eduardo Guimarães Hourneaux de Moura: Olympus – Consultant (Consulting fees), Boston Scientific – Consultant (Consulting fees); and other authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: All the authors in this manuscript have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guilherme Henrique Peixoto de Oliveira, MD, Medical Assistant, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr Enéas de Carvalho Aguiar, 225, São Paulo 05403-010, Brazil. guilherme.hpoliveira@hc.fm.usp.br
Received: May 27, 2022
Peer-review started: May 27, 2022
First decision: June 9, 2022
Revised: June 22, 2022
Accepted: October 26, 2022
Article in press: October 26, 2022
Published online: November 16, 2022
Processing time: 170 Days and 16.6 Hours
Abstract
BACKGROUND

The prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography (ERCP) is still controversial.

AIM

To assess whether antibiotic prophylaxis reduces the rates of complications in patients undergoing elective ERCP.

METHODS

This systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A comprehensive search of multiple electronic databases was performed. Only randomized controlled trials were included. The outcomes analyzed included bacteremia, cholangitis, sepsis, pancreatitis, and mortality. The risk of bias was assessed by the Cochrane revised Risk-of-Bias tool for randomized controlled trials. The quality of evidence was assessed by the Grading of Recommendation Assessment, Development, and Evaluation. Meta-analysis was performed using the Review Manager 5.4 software.

RESULTS

Ten randomized controlled trials with a total of 1757 patients that compared the use of antibiotic and non-antibiotic prophylaxis in patients undergoing elective ERCP were included. There was no significant difference between groups regarding incidence of cholangitis after ERCP [risk difference (RD) = -0.02, 95% confidence interval (CI): -0.05, 0.02, P = 0.32], cholangitis in patients with suspected biliary obstruction (RD = 0.02, 95%CI: -0.08 to 0.13, P = 0.66), cholangitis on intravenous antibiotic prophylaxis (RD = -0.02, 95%CI: -0.05 to 0.01, P = 0.25), septicemia (RD = -0.02, 95%CI: -0.06 to 0.01, P = 0.25), pancreatitis (RD = -0.02, 95%CI: -0.06 to 0.01, P = 0.19), and all-cause mortality (RD = 0.00, 95%CI: -0.01 to 0.01, P = 0.71]. However, the antibiotic prophylaxis group presented a 7% risk reduction in the incidence of bacteremia (RD= -0.07, 95%CI: -0.14 to -0.01, P = 0.03).

CONCLUSION

The prophylactic use of antibiotics in patients undergoing elective ERCP reduces the risk of bacteremia but does not appear to have an impact on the rates of cholangitis, septicemia, pancreatitis, and mortality.

Keywords: Endoscopy; Antibiotics; Endoscopic retrograde cholangiopancreatography; Cholangitis; Infection

Core Tip: There is controversy about antibiotic prophylaxis in patients undergoing elective endoscopic retrograde cholangiopancreatography. This is a systematic review and meta-analysis based on randomized controlled trials that analyzed whether the use of antibiotic prophylaxis is beneficial in preventing complications after this procedure. Outcomes evaluated include the rate of cholangitis, bacteremia, sepsis, pancreatitis, and mortality. Based on this meta-analysis, antibiotic prophylaxis reduces the risk of bacteremia but does not impact the rate of cholangitis, septicemia, pancreatitis, and mortality.