Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Is antibiotic prophylaxis necessary after endoscopic ultrasound-guided fine-needle aspiration of pancreatic cysts?

  • Seifeldin Hakim (Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School at UTHealth) ;
  • Mihajlo Gjeorgjievski (Division of Gastroenterology and Hepatology, Department of Internal Medicine, Oakland University William Beaumont School of Medicine) ;
  • Zubair Khan (Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School at UTHealth) ;
  • Michael E. Cannon (Division of Gastroenterology and Hepatology, Department of Internal Medicine, Oakland University William Beaumont School of Medicine) ;
  • Kevin Yu (Department of Internal Medicine, The University of Texas Health Science Center) ;
  • Prithvi Patil (Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School at UTHealth) ;
  • Roy Tomas DaVee (Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School at UTHealth) ;
  • Sushovan Guha (Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School at UTHealth) ;
  • Ricardo Badillo (Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School at UTHealth) ;
  • Laith Jamil (Division of Gastroenterology and Hepatology, Department of Internal Medicine, Oakland University William Beaumont School of Medicine) ;
  • Nirav Thosani (Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School at UTHealth) ;
  • Srinivas Ramireddy (Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School at UTHealth)
  • Received : 2021.05.07
  • Accepted : 2022.01.22
  • Published : 2022.11.30
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Abstract

Background/Aims: Current society guidelines recommend antibiotic prophylaxis for 3 to 5 days after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions (PCLs). The overall quality of the evidence supporting this recommendation is low. In this study, we aimed to assess cyst infection and adverse event rates after EUS-FNA of PCLs among patients treated with or without postprocedural prophylactic antibiotics. Methods: We retrospectively reviewed all patients who underwent EUS-FNA of PCLs between 2015 and 2019 at two large-volume academic medical centers with different practice patterns of postprocedural antibiotic prophylaxis. Data on patient demographics, cyst characteristics, fine-needle aspiration technique, periprocedural and postprocedural antibiotic prophylaxis, and adverse events were retrospectively extracted. Results: A total of 470 EUS-FNA procedures were performed by experienced endosonographers for the evaluation of PCLs in 448 patients, 58.7% of whom were women. The mean age was 66.3±12.8 years. The mean cyst size was 25.7±16.9 mm. Postprocedural antibiotics were administered in 274 cases (POSTAB+ group, 58.3%) but not in 196 cases (POSTAB- group, 41.7%). None of the patients in either group developed systemic or localized infection within the 30-day follow-up period. Procedure-related adverse events included mild abdominal pain (8 patients), intra-abdominal hematoma (1 patient), mild pancreatitis (1 patient), and perforation (1 patient). One additional case of pancreatitis was recorded; however, the patient also underwent endoscopic retrograde cholangiopancreatography. Conclusions: The incidence of infection after EUS-FNA of PCLs is negligible. Routine use of postprocedural antibiotics does not add a significant benefit.

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References

  1. Zhang XM, Mitchell DG, Dohke M, et al. Pancreatic cysts: depiction on single-shot fast spin-echo MR images. Radiology 2002;223:547-553. 
  2. Stark A, Donahue TR, Reber HA, et al. Pancreatic cyst disease: a review. JAMA 2016;315:1882-1893. 
  3. Tacelli M, Celsa C, Magro B, et al. Diagnostic performance of endoscopic ultrasound through-the-needle microforceps biopsy of pancreatic cystic lesions: systematic review with meta-analysis. Dig Endosc 2020;32:1018-1030. 
  4. European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018;67:789-804. 
  5. Bhutani MS, Gupta V, Guha S, et al. Pancreatic cyst fluid analysis: a review. J Gastrointestin Liver Dis 2011;20:175-180. 
  6. Morris-Stiff G, Lentz G, Chalikonda S, et al. Pancreatic cyst aspiration analysis for cystic neoplasms: mucin or carcinoembryonic antigen. Which is better? Surgery 2010;148:638-644. 
  7. Oppong KW, Dawwas MF, Charnley RM, et al. EUS and EUS-FNA diagnosis of suspected pancreatic cystic neoplasms: is the sum of the parts greater than the CEA? Pancreatology 2015;15:531-537. 
  8. Wiersema MJ, Vilmann P, Giovannini M, et al. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 1997;112:1087-1095. 
  9. Polkowski M, Jenssen C, Kaye P, et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline. March 2017. Endoscopy 2017;49:989-1006. 
  10. ASGE Standards of Practice Committee, Muthusamy VR, Chandrasekhara V, et al. The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. Gastrointest Endosc 2016;84:1-9. 
  11. Guarner-Argente C, Shah P, Buchner A, et al. Use of antimicrobials for EUS-guided FNA of pancreatic cysts: a retrospective, comparative analysis. Gastrointest Endosc 2011;74:81-86. 
  12. Facciorusso A, Buccino VR, Turco A, et al. Antibiotics do not decrease the rate of infection after endoscopic ultrasound fine-needle aspiration of pancreatic cysts. Dig Dis Sci 2019;64:2308-2315. 
  13. Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006;6:17-32. 
  14. Tanaka M, Fernandez-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012;12:183-197. 
  15. Vege SS, Ziring B, Jain R, et al. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015;148:819-822. 
  16. Tanaka M, Fernandez-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017;17:738-753. 
  17. Elta GH, Enestvedt BK, Sauer BG, et al. ACG clinical guideline: diagnosis and management of pancreatic cysts. Am J Gastroenterol 2018;113:464-479. 
  18. Barawi M, Gottlieb K, Cunha B, et al. A prospective evaluation of the incidence of bacteremia associated with EUS-guided fine-needle aspiration. Gastrointest Endosc 2001;53:189-192. 
  19. Lee LS, Saltzman JR, Bounds BC, et al. EUS-guided fine needle aspiration of pancreatic cysts: a retrospective analysis of complications and their predictors. Clin Gastroenterol Hepatol 2005;3:231-236. 
  20. Marinos E, Lee S, Jones B, et al. Outcomes of single-dose peri-procedural antibiotic prophylaxis for endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions. United European Gastroenterol J 2014;2:391-396. 
  21. Klein A, Qi R, Nagubandi S, et al. Single-dose intra-procedural ceftriaxone during endoscopic ultrasound fine-needle aspiration of pancreatic cysts is safe and effective: results from a single tertiary center. Ann Gastroenterol 2017;30:237-241. 
  22. Colan-Hernandez J, Sendino O, Loras C, et al. Antibiotic prophylaxis is not required for endoscopic ultrasonography-guided fine-needle aspiration of pancreatic cystic lesions, based on a randomized trial. Gastroenterology 2020;158:1642-1649.