Prophylactic antibiotics may be unnecessary in gastric endoscopic submucosal dissection due to the low incidence of bacteremia.

Abstract

Endoscopic submucosal dissection (ESD) was developed as a feasible and reliable treatment for gastrointestinal mucosal or submucosal lesions. Bacteremia may occur after ESD. Currently, the use of prophylactic antibiotics after gastric ESD is controversial. This study was designed to explore the value of prophylactic antibiotics in the treatment of gastric mucosal and submucosal lesions after ESD. In this prospective study, in total, 103 patients who underwent gastric ESD were included, and the frequency of bacteremia and changes in inflammation-related indicators before and after the procedure were investigated. The patients did not receive prophylactic antibiotics. The body temperature (T), white blood cell count (WBC), and procalcitonin (PCT) and C-reactive protein (CRP) levels did not significantly differ between the perforation group (N = 40) and nonperforation group before gastric ESD (N = 63) (all P > 0.05). The T, WBC, and CRP levels (all P < 0.05) in the patients with perforation were significantly higher than those in the patients without perforation 24h after gastric ESD. The incidence of bacteremia did not significantly differ between the two groups (all P > 0.05). In total, 6 of 309 blood cultures were cultured with bacteria. The total frequency of bacteremia in the perforation and nonperforation groups was 2.5% and 3.2%, respectively. No sepsis occurred in any patients. Regardless of whether perforation occurred after gastric ESD, the incidence of bacteremia was transient and low. Therefore, based on our single-center study in China, prophylactic antibiotics may not be necessary in patients with intraoperative perforation during gastric ESD. A single-center prospective study at chictr.org.cn (ChiCTR1800019668).