Xue M, Zhong J, Zhu JN, Wu J, Zhong DD, Zhu CP, Chen Y, Wang LL, Hong YP, Wei W. Prophylactic antibiotics confer no advantage in elective endoscopic treatment for cirrhotic patients with gastroesophageal variceal bleeding history. World J Hepatol 2026; 18(10): 124749 [DOI: 10.4254/wjh.124749]
Corresponding Author of This Article
Wei Wei, Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. wwze@zju.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
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research-article
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Xue M, Zhong J, Zhu JN, Wu J, Zhong DD, Zhu CP, Chen Y, Wang LL, Hong YP, Wei W. Prophylactic antibiotics confer no advantage in elective endoscopic treatment for cirrhotic patients with gastroesophageal variceal bleeding history. World J Hepatol 2026; 18(10): 124749 [DOI: 10.4254/wjh.124749]
Meng Xue, Jing Zhong, Jia-Ning Zhu, Jia Wu, Dan-Dan Zhong, Chun-Peng Zhu, Yan Chen, Ling-Ling Wang, Wei Wei, Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Yi-Ping Hong, Department of Gastroenterology, The Affiliated Jinhua Hospital, School of Medicine, Zhejiang University, Jinhua 321000, Zhejiang Province, China
Co-corresponding authors: Yi-Ping Hong and Wei Wei.
Author contributions: Hong YP and Wei W contribute equally to this study as co-corresponding authors; Xue M conducted the study and wrote the paper; Zhong J and Zhu JN contributed to the analysis and figure preparation; Wu J, Zhong DD, Zhu CP, Chen Y and Wang LL collected data and provided clinical advice; and Hong YP and Wei W designed and supervised the study.
AI contribution statement: All the authors report no use of artificial intelligence tools in the preparation of the manuscript.
Supported by the Chronic Disease Management Research Project of National Health Commission Capacity Building and Continuing Education Center, No. GWJJMB202510025159; Medical and Health Science Program of Zhejiang Province, No. 2025HY0403; and Natural Science Foundation of Zhejiang Province, No. LTGD24H030001.
Institutional review board statement: This study was reviewed and approved by the Ethical Review Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine (No. 2026-0728).
Informed consent statement: Patients were not required to give informed due to retrospective study design. The waive of informed consent was approved by the Ethical Review Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine.
Conflict-of-interest statement: The authors have no conflicts of interest or financial ties to disclose.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at wwze@zju.edu.cn.
Corresponding author: Wei Wei, Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. wwze@zju.edu.cn
Received: June 24, 2026 Revised: July 18, 2026 Accepted: September 8, 2026 Published online: October 27, 2026 Processing time: 119 Days and 17.4 Hours
Abstract
BACKGROUND
The necessity of routine preoperative antibiotic prophylaxis (AP) for elective endoscopic treatment of gastroesophageal varices (GEV) remains controversial.
AIM
To evaluate whether preoperative AP is beneficial in elective endoscopic treatment for patients with previous bleeding history of GEV.
METHODS
In this retrospective case-control study, cirrhotic patients with a previous history of GEV bleeding who were readmitted for elective endoscopic treatment were enrolled. Patients who received no preoperative antibiotics were assigned to the antibiotic-free (AF) group, while those who received preoperative cephalosporin infusion before endoscopic intervention were assigned to the AP group. The use of antibiotics was determined by physician experience. Postoperative bacterial infection, 3-month rebleeding rate, and other clinical outcomes were compared between the two groups.
RESULTS
A total of 442 patients (220 in the AF group, and 222 in the AP group) were included in the final analysis. The incidence of post-operative bacterial infection was 18.6% in the AF group and 17.6% in the AP group (P > 0.05). Three-month rebleeding rates were 5.9% and 7.2% in the AF group and AP group (P > 0.05), respectively. Stratified analyses using the Sarin classification of GEV, endoscopic modality, Child-Pugh grade, and cirrhosis etiology demonstrated no significant difference in postoperative bacterial infection rate between the AF and AP groups.
CONCLUSION
Preoperative AP does not confer benefits in elective endoscopic treatment for patients with a previous history of GEV bleeding.
Core Tip: The necessity of routine preoperative antibiotic prophylaxis (AP) for elective endoscopic treatment of gastroesophageal varices in cirrhotic patients remains controversial. In this retrospective case-control trial, similar rates of postoperative bacterial infection and 3-month rebleeding were found between patients who received AP and those who did not, indicating that preoperative AP does not confer additional benefit in elective endoscopic treatment for cirrhotic patients with a previous history of gastroesophageal variceal bleeding.
