Value of antibiotic prophylaxis after endoscopic retrograde cholangio-pancreatography

Abstract

Objective To investigate the effects of antibiotic prophylaxis on post-operation complications after endoscopic retrograde cholangio-pancreatography (ERCP). Methods From January 1st, 2011 to December 31st, 2013, 1 951 patients undergoing ERCP were enrolled and divided into postoperative antibiotic prophylaxis group (antibiotics group, 630 cases) and postoperative non-antibiotic treatment group (non-antibiotics group, 1 321 cases). Complications after ERCP were compared between the two groups. Chi square test, single factor analysis and multiple factor analysis were performed for statistical analysis. Results Among the 1 951 patients, 277 patients had postoperative complications: 101 patients (5.18%) with post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP), 54 patients (2.77%) with hyperamylasemia, 134 patients (6.87%) with biliary infection, eight patients (0.41%) with hemorrhage, one patient (0.05%) with intestinal obstruction and one patient (0.05%) with perforation. The incidence of postoperative biliary infection of antibiotics group was 4.44%(28/630), which was lower than that of non-antibiotics group (8.02%, 106/1 321), and the difference was statistically significant (χ2=8.546, P=0.030). The incidences of PEP of antibiotics group and non-antibiotics group were 4.92% (31/630) and 5.30% (70/1 321), respectively. The incidences of postoperative hyperamylasemia of antibiotics group and non-antibiotics group were 3.02%(19/630) and 2.65%(35/1 321), respectively. The incidences of upper gastrointestinal hemorrhage were 3.02%(19/630) and 2.65%(35/1 321), respectively. The incidences of intestinal obstruction were 0(0/630) and 0.08%(1/1 321), respectively, while the incidences of perforation post-operation were 0.16%(1/630) and 0(0/1 321), respectively, and the differences were not statistically significant (all P>0.05). Cholangiocarcinoma (odd ratios (OR)=2.93, 95% confidence interval (CI) 1.88 to 4.56, P<0.01) and repeated ERCP during hospitalization (OR=2.53, 95% CI 1.63 to 3.93, P<0.01) were the independent risk factors of cholangitis after operation. However, endoscopic sphincterotomy (OR=0.65, 95%CI 0.44 to 0.97, P=0.030) and antibiotics prophylaxis (OR=0.64, 95%CI 0.39 to 0.95, P=0.030) were the protective factors. Conclusions Antibiotic prophylaxis after ERCP can reduce the occurrence of postoperative cholangitis. Paitents with cholangiocarcinoma, repeated ERCP procedures during hospitalization or without endoscopic sphincterotomy should be recommended for antibiotic prophylaxis. Key words: Cholangiopancreatography, endoscopic retrograde; Antibiotic prophylaxis; Complications