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
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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]
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, Eduardo Guimarães Hourneaux de Moura, Wanderley Marques Bernardo, Sergio A Sánchez-Luna, Caroline Moll, Edson Ide, Epifanio Silvino do Monte Junior, Igor Mendonça Proença, Guilherme Henrique Peixoto de Oliveira, Diogo Turiani 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.
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.
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.
