Role of intraductal antibiotic in preventing cholangitis in post-endoscopic retrograde cholangiopancreatography patients

Abstract

Background Acute cholangitis is one of the most serious life-threatening post-endoscopic retrograde cholangiopancreatography (ERCP) complications. Some have suggested that bacteria may play a role in the induction of post-ERCP cholangitis. Routine prophylactic systemic antibiotic use has an important role in reducing post-ERCP bacteremia. However, the beneficial effects of antibiotic use on preventing post-ERCP cholangitis are unclear. Aim The aim of the study was to assess post-ERCP cholangitis after intraductal antibiotic therapy in patients with obstructive jaundice. Patients and methods This cross-sectional prospective study was conducted on 60 Egyptian patients presented with obstructive jaundice who undergo elective ERCP procedure. In all, 20 patients received prophylactic intraductal 1 g ceftriaxone in contrast media; 20 patients received prophylactic intravenous ceftriaxone and 20 patients did not receive antibiotics. Pre-ERCP and post-ERCP laboratory tests and imaging were used to assess post-ERCP cholangitis. The study endpoint was developing cholangitis within 72 h after ERCP. Results There was highly significant increase in post-ERCP cholangitis in patients who did not receive antibiotics in comparison to other groups. Conclusion The use of prophylactic antibiotic prior to elective ERCP has a significant role in decreasing the frequency of post-ERCP cholangitis.