RISK OF MICROBIAL TRANSLOCATION IN PER-ORAL ENDOSCOPIC MYOTOMY (POEM) FOR ACHALASIA: ANTIBIOTIC PROPHYLAXIS OR SHORT-THERAPY? AN INTERIM ANALYSIS OF A PROSPECTIVE RANDOMIZED CLINICAL TRAIL

Aims:

Microbial translocation (MT) is the passage of viable/nonviable microbes across the GI-barrier. Presence of Lipopolysaccharide (LPS) of Gram-negatives and LPS-binding protein (LBP) in the plasma correlates to sepsis/septic shock through the activation of inflammation (IN) via soluble-CD14 (sCD14) and consequent cytokines production (IL-6, IL-1b, TNF-α). Considering POEM a clean-contaminated procedure it should be assessed whether the post-POEM fever/inflammation is cytokine-mediated or infection-related. Aim of the study was to evaluate markers of MT, IN and bacteremia post POEM.

Methods:

Consecutive POEM patients since June 2016 were enrolled and randomized in two groups: Group-A (antibiotics only before procedure) and Group-B (antibiotics before POEM, continued for 24h and then orally for 3 days). At planned timing (T0, T1, T2: before, after and 24h after POEM, respectively) we evaluated plasma dosage of: IL-6, IL-1β, TNF-α (IN) and sCD14, LPB (MT). Blood cultures (BC) and body temperature (BT) were collected at T0-T1-T2, C-reactive Protein (CRP) was evaluated at T0 and T2.

Results:

The first 73 patients (age 56.15 ± 16.2 years, M/F 37/36) did not experienced a significant post-operative fever, except for 4 patients, 2 in each groups. However both groups showed a significant increasing CRP, LBP, IL-6 and IL-1b at T2 compared to T0. At T2 Group-A subjects had higher values of LBP whereas the other markers did not show any difference between groups (Table1). A total of 6 patients had positive BCs, 4 at T0 of which only 1 also positive at T1, and 2 at T1, negative at T2. All BCs were negative at T2.

Conclusions:

In our preliminary results the increasing observed levels of inflammation as well as of markers of MT after POEM might suggest MT as a possible mechanism of inflammation activation. The presence of post-operative IN and MT resulted to be independent from the type of administered antimicrobials.