Background and study aims: Choledochoscopy is increasingly performed during endoscopic retrograde cholangiopancreatography
(ERCP) for direct bile duct visualization. Choledochoscopy necessitates irrigation
of the bile duct with water or saline, which may increase intrabiliary pressure and
consequently the risks of bacteremia and cholangitis. The aim of this study was to
prospectively evaluate the risk of bacteremia and infectious complications in patients
undergoing single-operator choledochoscopy (SOC).
Patients and methods: Patients requiring ERCP with SOC at two tertiary care centers were enrolled prospectively.
Blood cultures were obtained immediately before the ERCP, after completion of the
ERCP portion of the procedure (to determine ERCP-related bacteremia), and 15 minutes
after completion of SOC.
Results: A total of 72 patients (mean age 64 years; 51.4 % male) underwent ERCP with SOC.
True positive blood cultures were noted in 20 patients (27.8 %; 95 % confidence interval
[CI] 17.86 % – 39.59 %), of whom 6 patients (8.3 %; 95 %CI 3.12 % – 17.26 %) had transient
bacteremia following ERCP. Of 14 patients (19.4 %; 95 %CI 11.05 % – 30.46 %) with
sustained bacteremia following ERCP or SOC, 10 patients (13.9 %; 95 %CI 6.86 % – 24.06 %)
had sustained bacteremia related to SOC. Despite the use of post-procedure intravenous
antibiotic administration, seven patients (9.7 %; 95 %CI 3.99 – 19.01 %) required
further antibiotic treatment for infectious complications, three of whom (4.2 %; 95 %CI
0.86 % – 11.69 %) were hospitalized in order to receive intravenous antibiotic therapy.
Conclusion: The bacteremia associated with ERCP with SOC and the subsequent risk of hospitalization
for infectious complications suggest that preprocedure antibiotic prophylaxis should
be considered for patients undergoing SOC, particularly in older patients and those
with prior stent placement or undergoing intraductal stone lithotripsy.
Trial registration: clinical trials.gov (NCT01414400).
