Aims Larger colorectal lesions tend to have a higher risk of infection after endoscopic
mucosal resection (EMR) or endoscopic submucosal dissection (ESD), possibly because
of the larger wound areas. There have been conflicting studies on prophylactic antibiotics
in the prevention of infection in patients who underwent EMR or ESD.
Methods A comprehensive literature search from the PubMed Central, Embase, Cochrane Library,
and Ovid was performed with the following search terms: prophylaxis, antibiotics,
EMR, and ESD. Four studies were selected and validated using the Jadad scale. Trial
results were combined under a fixed-effects model. The Cochrane Review Manager Software
version 5.0 was used for all analyses. The primary outcome of study was prevention
of post-procedural infection as an adverse clinical outcome.
Results Four trials comprising of 850 patients met the inclusion criteria. Three studies
were prospective randomized controlled trials while one was a retrospective case control.
In the fixed effect model, it showed a statistically significant decrease in the infection
rates (p< 0.00001) among patients who were given antibiotic prophylaxis compared to
those without (2.9% vs. 26.7% infection rate; OR 0.21, 95% CI: 0.11-0.38). The four
trials showed moderate heterogeneity (I2= 36%) since the study by Muro (2015) was of retrospective method. Reconstructing
the forest plot analyzing only the prospective studies minimized heterogeneity (I2= 0%).
Conclusions Prophylactic antibiotics given pre- and post-endoscopic resection have shown favorable
outcomes in the prevention of infection post-procedure. Nevertheless, further studies
on the optimal antibiotic drug class, dosage and duration is recommended.
