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UEG Presentation

PROPHYLACTIC ANTIBIOTICS REDUCE POST ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY INFECTIOUS COMPLICATIONS IN PATIENTS WITH DISTAL MALIGNANT BILIARY OBSTRUCTION: A MULTICENTER PROPENSITY SCORE MATCHED STUDY

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PROPHYLACTIC ANTIBIOTICS REDUCE POST ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY INFECTIOUS COMPLICATIONS IN PATIENTS WITH DISTAL MALIGNANT BILIARY OBSTRUCTION: A MULTICENTER PROPENSITY SCORE MATCHED STUDY

Haruna Takahashi 1, Tatsunori Satoh 1, Yosuke Kobayashi 2, Fumitaka Niiya 3, Junichi Kaneko 4, Kazuma Ishikawa 5, Shinya Kawaguchi 1

Affiliations

1 Shizuoka General Hospital, Shizuoka, Japan

2 Seirei Hamamatsu General Hospital, Shizuoka, Japan

3 Showa University Fujigaoka Hospital, Yokohama, Japan

4 Iwata City Hospital, Shizuoka, Japan

5 Sapporo Medical University, Sapporo, Japan

Summary

AI Generated

Prophylactic antibiotics significantly reduced post-ERCP infectious complications in patients with distal malignant biliary obstruction undergoing initial stent placement in a retrospective propensity-matched study of 330 patients.

In the matched cohort (165 per group), prophylactic antibiotics reduced overall infectious complications (cholangitis or cholecystitis within 5 days) from 10.3% to 3.6% (risk difference 6.7%, p=0.029, NNT 14.9).
The benefit was driven by a significant reduction in cholangitis from 7.9% to 2.4% (p=0.043, risk ratio 3.25), while cholecystitis rates showed no significant difference (2.4% vs. 1.2%, p=0.685).
Multivariable logistic regression confirmed that absence of prophylactic antibiotics was independently associated with higher risk of infectious complications (odds ratio 2.45, 95% CI 1.22–4.92).
Post-ERCP pancreatitis rates did not differ significantly between groups (6.1% without antibiotics vs. 9.7% with antibiotics, p=0.307).
Study limitations include residual confounding, lack of systematic antibiotic resistance assessment, absence of bacteremia evaluation, and single-country design limiting generalizability.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Malignant biliary obstruction (MBO) often necessitates endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage. Although ERCP is standard treatment, post-procedural infections such as cholangitis and cholecystitis remain clinically important. Current guidelines recommend prophylactic antibiotics only for high-risk cases. Clinically, MBO is categorized into distal malignant biliary obstruction (DMBO) and hilar malignant biliary obstruction (HMBO), depending on whether the obstruction involves the extrahepatic duct or the intrahepatic duct/hilar confluence. While several studies have supported the use of prophylactic antibiotics in HMBO, evidence remains limited for DMBO. This study aimed to evaluate the effect of prophylactic antibiotics on post-ERCP infectious complications in DMBO.

Aims & Methods

We retrospectively reviewed patients who underwent initial ERCP with stent placement for DMBO at five Japanese centers between January 2020 and September 2024. Patients were grouped based on the use or non-use of prophylactic antibiotics for ERCP. Propensity score matching (1:1) was performed using clinically relevant covariates. In addition, a sensitivity analysis was conducted via multivariable logistic regression on the before matched data to further assess the robustness of the findings. The primary outcome was the incidence of infectious complications (cholangitis or cholecystitis) within five days of ERCP.

Results

A total of 508 patients (304 in the antibiotic group, 204 in the non-antibiotic group) were included in the study. After PSM, 165 patients were selected for each group. Characteristics of the antibiotic vs. non-antibiotic groups included: median age 74 years in both groups; sex 92 (55.8%) males vs. 94 (57.0%) males; pancreatic cancer 129 (77.2%) cases vs. 133 (79.6%) cases; plastic stents 72 (43.6%) cases vs. 69 (41.8%) cases.
In the matched population, the incidence of overall infectious complications (cholangitis or cholecystitis) was significantly lower in the prophylactic antibiotic group than in the non-antibiotic group (3.6% vs. 10.3%; risk difference (RD), 6.7%; p=0.029), corresponding to a number needed to treat (NNT) of 14.9. No significant difference was observed in the rate of post-ERCP pancreatitis: 10 patients (6.1%) in the non-antibiotic group and 16 patients (9.7%) in the antibiotic group (p = 0.307). Sensitivity analysis using multivariable logistic regression confirmed that absence of prophylactic antibiotics was independently associated with a higher risk of infectious complications (odds ratio: 2.45, 95% confidence interval: 1.22–4.92).

After mating cohort	Without antibiotics (n = 165)	With antibiotics (n=165)	Risk difference (%)	NNT	Risk ratio	P value
Infectious complications	17 (10.3)	6 (3.6)	6.7 (1.2 - 12.1)	14.9 (8.3-83.3)	2.83 (1.15 - 7.01)	0.029
mild/ moderate	9/8	3/3
Cholangitis	13 (7.9)	4 (2.4)	5.5 (0.7 - 10.2)	18.2 (9.8-142.9)	3.25 (1.08 - 9.76)	0.043
mild/ moderate	9/4	3/1
Cholecystitis	4 (2.4)	2 (1.2)	1.2 (-1.7 - 4.1)	83.3 (24.4-∞)	2.00 (0.37 - 10.77)	0.685
mild/ moderate	0/4	0/2