Published online Nov 16, 2022. doi: 10.4253/wjge.v14.i11.718
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
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.
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.
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.
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.
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).
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.
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.