Antibiotics for fever in patients without perforation after gastric endoscopic submucosal dissection and endoscopic submucosal excavation may be unnecessary: a propensity score-matching analysis

Yongkang Lai,Xu Shu,Zhenhua Zhu,Xiaolin Pan,Guohua Li,Youxiang Chen,Yin Zhu,Xiaojiang Zhou,Qian Zhang,Shunhua Long

doi:10.1186/s12876-021-01602-1

Abstract

BackgroundEndoscopic submucosal dissection (ESD) and endoscopic submucosal excavation (ESE) have been widely used and have gradually become the main endoscopic treatment for gastrointestinal mucosal and submucosal lesions. Whether antibiotics are necessary for fever after gastric ESD and ESE remain unclear. The aim of this study was to analyse the value of using antibiotics in patients without perforation after ESD or ESE with fever.MethodsIn this retrospective study, patients with fever without perforation after ESD or ESE from January 2014 to January 2019 were included and divided into 2 groups: the antibiotic group and the non-antibiotic group. Fever and hospitalization time were compared between the 2 groups after propensity score matching.ResultsOverall, 253 patients meeting the inclusion criteria were enrolled in the present study, with 186 patients in the non-antibiotic group and 67 patients in the antibiotic group before matching, 55 patients in the non-antibiotic group and 55 patients in the antibiotic group after matching with all baseline characteristics balanced (p > 0.05). The duration of fever was not significantly different between the 2 groups (p = 0.12). However, the median hospitalization stay in the antibiotic group was longer than that in the non-antibiotic group (8 vs 7, p = 0.007).ConclusionsAntibiotics may be unnecessary for fever in patients without perforation and without serious co-morbidities after gastric ESD or ESE.

Highlights

Endoscopic submucosal dissection (ESD) and endoscopic submucosal excavation (ESE) have been widely used and have gradually become the main endoscopic treatment for gastrointestinal mucosal and submucosal lesions
Many studies have shown that continuous submucosal defects caused by ESD or ESE may increase the risk of bacteraemia and/or endotoxaemia, the rate of bacteraemia after procedure remains low or the bacteraemia is transient
It remains uncertain whether antibiotics are necessary for patients with fever after gastric ESD or ESE, especially for those without perforation during or after procedure, since post-ESD bacteraemia is transient and the use of antibiotics will increase the cost of hospitalization

Summary

Introduction

Endoscopic submucosal dissection (ESD) and endoscopic submucosal excavation (ESE) have been widely used and have gradually become the main endoscopic treatment for gastrointestinal mucosal and submucosal lesions. Whether antibiotics are necessary for fever after gastric ESD and ESE remain unclear. The researchers concluded that prophylactic antibiotics might not be necessary for patients after ESD or ESE [8,9,10,11,12]. These studies only focused on whether antibiotics were used in advance after ESD or ESE It remains uncertain whether antibiotics are necessary for patients with fever after gastric ESD or ESE, especially for those without perforation during or after procedure, since post-ESD bacteraemia is transient and the use of antibiotics will increase the cost of hospitalization. The purpose of this study was to analyse whether fever after ESD or ESE should be treated with antibiotics in patients without perforation

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