Prophylactic antibiotics confer no advantage in elective endoscopic treatment for cirrhotic patients with gastroesophageal variceal bleeding history

doi:10.4254/wjh.124749

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World Journal of Hepatology

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1948-5182

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Hepatol. Oct 27, 2026; 18(10): 124749
Published online Oct 27, 2026. doi: 10.4254/wjh.124749

Table 1 Baseline characteristics of enrolled patients, n (%) or median (interquartile range) or mean ± SD

Characteristics	AF (n = 220)	AP (n = 222)	P value
Male	164 (74.5)	154 (69.4)	0.226
Age (≥ 60 years)	105 (47.7)	121 (54.5)	0.154
Etiology of cirrhosis
Hepatitis B	100 (45.5)	97 (43.7)	0.710
Alcohol	65 (29.5)	62 (27.9)	0.707
Autoimmune	16 (7.3)	14 (6.3)	0.686
Schistosomiasis	7 (3.2)	11 (5.0)	0.346
Wilson’s disease¹	2 (0.9)	4 (1.8)	0.685
MASLD	10 (4.5)	12 (5.4)	0.678
Hepatitis C¹	3 (1.4)	1 (0.5)	0.371
Cryptogenic cirrhosis	17 (7.7)	21 (9.5)	0.516
Type of GEV
EV	201 (91.4)	209 (94.1)	0.259
GV	205 (93.2)	198 (89.2)	0.139
GOV1	149 (67.7)	139 (62.6)	0.259
GOV2	23 (10.5)	30 (13.5)	0.322
GOV3	14 (6.4)	16 (7.2)	0.724
IGV1	17 (7.7)	13 (5.9)	0.434
IGV2¹	2 (0.9)	0 (0.0)	0.247
Child-Pugh class
A	141 (64.1)	139 (62.6)	0.747
B + C	79 (35.9)	83 (37.7)
HVPG (≥ 12 mmHg)²	86 (51.5)	101 (56.7)	0.329
Diabetes	65 (29.3)	58 (26.1)	0.423
Hypertension	53 (23.9)	58 (26.1)	0.622
Portal vein thrombosis	46 (20.7)	51 (23.0)	0.600
Ascites	141 (63.5)	150 (67.6)	0.441
BMI (kg/m²)	22.25 (20.53, 24.28)	22.09 (20.28, 24.52)	0.831
ALT (U/L)³	25.5 (19.0, 34.8)	27.0 (20.0, 36.3)	0.414
AST (U/L)³	34.0 (28.0, 45.8)	36.0 (30.0, 46.0)	0.205
Albumin (g/L)	37.9 ± 5.1	37.7 ± 4.9	0.593
Total bilirubin (μmol/L)³	20.5 (13.3, 27.8)	18.1 (14.3, 25.1)	0.754
PT (second)³	14.9 (14.0, 15.8)	14.7 (14.1, 15.8)	0.608
WBC count (10⁹/L)³	3.0 (2.3, 4.2)	3.3 (2.4, 4.6)	0.134
Neutrophil count (10⁹/L)³	1.8 (1.3, 2.6)	1.9 (1.4, 2.7)	0.623
Hemoglobin (g/dL)³	10.5 ± 2.4	10.7 ± 2.3	0.202
Platelet count (10⁹/L)³	66.0 (43.0, 103.8)	69.0 (44.0, 123.8)	0.300

¹Fisher’s exact test was used.

²The value of hepatic venous pressure gradient was available in only a proportion of recruiters (antibiotic-free: 167, antibiotic prophylaxis: 178).

³Non-parametric Mann-Whitney U test was used.

AF: Antibiotic-free; AP: Antibiotic prophylaxis; GEV: Gastroesophageal varices; EV: Esophageal varices; GV: Gastric varices; GOV1: Gastroesophageal varices type 1; GOV2: Gastroesophageal varices type 2; GOV3: Gastroesophageal varices type 3; IGV1: Isolated gastric varices type 1; IGV2: Isolated gastric varices type 2; MASLD: Metabolic dysfunction-associated steatotic liver disease; HVPG: Hepatic venous pressure gradient; BMI: Body mass index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; PT: Prothrombin time; WBC: White blood cell.

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Table 2 Endoscopic methods used for secondary prophylaxis, n (%)

Methods	AF	AP	P value
ECI	138 (62.7)	137 (61.7)	0.826
EVL	116 (52.7)	118 (53.2)	0.929
EIS	20 (9.1)	17 (7.7)	0.586

AF: Antibiotic-free; AP: Antibiotic prophylaxis; EIS: Endoscopic injection sclerotherapy; EVL: Endoscopic variceal ligation; ECI: Endoscopic cyanoacrylate injection.

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Table 3 Stratified analysis of postoperative bacteria infection risk, n (%)

Characteristics	Infection rate in AF	Infection rate in AP	P value
Type of GEV
EV	36 (17.9)	36 (17.2)	0.855
GV	41 (18.6)	38 (17.1)	0.838
GOV1	27 (18.1)	27 (19.4)	0.777
GOV2	5 (21.7)	5 (16.7)	0.640
GOV3¹	4 (28.6)	3 (18.8)	0.675
IGV1¹	4 (23.5)	3 (23.1)	1.000
IGV2¹	1 (50.0)	0 (0.0)	1.000
Endoscopic method
ECI	24 (17.4)	27 (19.7)	0.621
EVL	28 (24.1)	25 (21.2)	0.590
EIS¹	2 (10.0)	1 (5.9)	1.000
Child-Pugh class
A	20 (14.2)	22 (15.8)	0.700
B + C	21 (26.6)	17 (20.5)	0.360
Etiology of cirrhosis
Hepatitis B	19 (19.0)	18 (18.6)	0.937
Alcohol	12 (18.5)	12 (19.4)	0.898
Autoimmune¹	4 (25.0)	2 (14.3)	0.657
Schistosomiasis¹	2 (28.6)	3 (27.3)	1.000
Wilson’s disease¹	0 (0.0)	0 (0.0)	1.000
MASLD¹	1 (9.1)	1 (8.3)	1.000
Hepatitis C¹	1 (33.3)	0 (0.0)	1.000
Cryptogenic cirrhosis¹	2 (11.8)	3 (14.3)	1.000

¹Fisher’s exact test was used.

AF: Antibiotic-free; AP: Antibiotic prophylaxis; GEV: Gastroesophageal varices; EV: Esophageal varices; GV: Gastric varices; GOV1: Gastroesophageal varices type 1; GOV2: Gastroesophageal varices type 2; GOV3: Gastroesophageal varices type 3; IGV1: Isolated gastric varices type 1; IGV2: Isolated gastric varices type 2; MASLD: Metabolic dysfunction-associated steatotic liver disease; EIS: Endoscopic injection sclerotherapy; EVL: Endoscopic variceal ligation; ECI: Endoscopic cyanoacrylate injection.

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Table 4 Postoperative inflammatory indices, median (interquartile range) or n (%)

Variables	AF	AP	P value
WBC count (10⁹/L)¹	3.3 (2.7, 4.4)	3.5 (2.6, 4.7)	0.241
Neutrophil count (10⁹/L)¹	2.2 (1.7, 3.0)	2.3 (1.7, 3.3)	0.684
Neutrophil percent (%)¹	68.4 (60.1, 75.1)	67.5 (57.0, 73.6)	0.229
C-reactive protein (> 10 mg/L)¹	4.6 (1.8, 6.7)	4.5 (1.6, 6.4)	0.414

¹Non-parametric Mann–Whitney U test was used.

AF: Antibiotic-free; AP: Antibiotic prophylaxis; WBC: White blood cell.

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Citation: 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
URL: https://www.wjgnet.com/1948-5182/full/v18/i10/124749.htm
DOI: https://dx.doi.org/10.4254/wjh.124749

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]

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