ANTIBIOTIC PROPHYLAXIS FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP): A SYSTEMATIC REVIEW AND META-ANALYSIS

Aims The prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography is still controversial. The literature is yet conflicting about indications. The iam of this meta-analysis is to assess antibiotic prophylaxis to reduce the incidence of septicemia and cholangitis in patients undergoing elective ERCP.

Methods This systematic review and meta-analysis. Searches were performed on databases: MEDLINE, EMBASE, and Cochrane Central. The risk of bias assessment was performed using the Cochrane revised Risk-of-Bias tool for randomized trials (ROB-2) and for non-randomized studies (ROBINS-1). The quality of evidence was assessed using standards of the Grading of Recommendation Assessment, Development and Evaluation (GRADEpro). The software tool used to evaluate the meta-analysis was the Review Manager 5.

Results Seven randomized and two observational studies were included, with a total of 1542 patients. The randomized clinical trials (RCT) and observational studies were analyzed separately. The RCT showed a reduction of 3% in the risk of cholangitis after ERCP (RD -0.03; IC -0.05 -0.01; P=0.009). Regarding septicemia, the RCTs demonstrated a risk reduction of 10% on the antibiotic prophylaxis group. Considering the randomized work on an evaluation of septicemia, there was a 10% reduction, no risk of sepsis, in the group that had antibiotic prophylaxis 10% [CI (-0.15, -0.05); P<0.0001]. However, the observational studies evidenced a benefit for the group that did not have prophylactic antibiotics with an [RD 0.22; IC (0.09-0.34); P=0.0007].

Conclusions The prophylactic use of antibiotics in patients undergoing elective ERCP can reduce the risk of cholangitis and bacteremia.

Publication History

Article published online:
14 April 2022