Merchan MFS, de Moura DTH, de Oliveira GHP, Proença IM, do Monte Junior ES, Ide E, Moll C, Sánchez-Luna SA, Bernardo WM, de Moura EGH. Antibiotic prophylaxis to prevent complications in endoscopic retrograde cholangiopancreatography: A systematic review and meta-analysis of randomized controlled trials. World J Gastrointest Endosc 2022; 14(11): 718-730 [PMID: 36438881 DOI: 10.4253/wjge.v14.i11.718]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
The prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography (ERCP) is controversial. The most common adverse events include bacteremia, cholangitis, and pancreatitis. Although recent guidelines regarding antibiotic prophylaxis for ERCP do not recommend its routine use, the data to support this recommendation is not robust.
Research motivation
Antimicrobial drug resistance is a global health problem that causes a high impact and inflicts an enormous economic burden worldwide. The World Health Organization reported that the ratio of morbidity and the mortality rate of diseases due to the spreading of multidrug resistant strains will lead to a substantial economic loss by 2050. Due to the lack of data in the literature, we performed a systematic review and meta-analysis to evaluate whether antibiotic prophylaxis impacts the rate of complications related to elective ERCP.
Research objectives
This systematic review and meta-analysis aimed to assess whether antibiotic prophylaxis reduced the rates of complications such as bacteremia, cholangitis, sepsis, pancreatitis, and mortality in patients undergoing elective ERCP.
Research methods
This systematic review and meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A comprehensive search of multiple electronic databases was performed only including randomized controlled trials.
Research results
Ten randomized clinical 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 the incidence of cholangitis [risk difference (RD) = -0.02, 95% confidence interval (CI): -0.05 to 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).
Research conclusions
Considering our findings, antibiotic prophylaxis in patients undergoing elective ERCP reduces the risk of bacteremia. Still, it does not appear to impact the rate of other adverse events.
Research perspectives
Antibiotics are highly prescribed drugs in clinical practice, but they can have adverse effects. Larger randomized controlled trials regarding the use of prophylactic antibiotics on ERCP in specific populations of patients are still warranted.
