Concise Commentary: Antibiotic Prophylaxis for Endoscopic Needle Aspiration of Pancreatic Cystic Lesions: Bursting the Bubble?

Excerpt

Endoscopic ultrasound (EUS) fine-needle aspiration (FNA) is commonly performed during endoscopic evaluation of pancreatic cystic lesions (PCL), a technique that has revolutionized the diagnosis and management of these lesions. Since biopsy of these lesions requires introducing a needle from the contaminated GI tract into the (presumably) sterile lesion, empiric (prophylactic) administration of post-procedural antibiotics has been adopted, although few data support this practice. ASGE and ESGE guidelines recommend prophylactic antibiotic use for EUS-guided sampling of cystic lesions [1, 2], usually with a single intravenous dose of an antibiotic given after the procedure followed by oral therapy for 3–5 days. This recommendation was based on 457 patients who underwent EUS FNA of 554 lesions, of which only 22 were cysts with 14% having complications after cyst FNA [3]. Since 1997, when this report was published, multiple studies have shown EUS FNA of PCL to be safe with a low risk of complications. For example, a single-center retrospective study of 253 patients showed no benefit for antibiotic prophylaxis with the only case of suspected cyst infection occurring in a patient who had antibiotic prophylaxis [4]. The results of a multicenter, randomized, double-blind clinical trial of 226 patients evaluating prophylactic antibiotic use were recently reported in abstract form; since no cyst infection occurred in either group, the authors concluded that no prophylaxis was not inferior to ciprofloxacin prophylaxis in preventing cyst infection after EUS FNA [5]. Finally, a recent meta-analysis showed that risk of infections after EUS FNA of PCL was 0.44%, and that incidence of adverse events associated with prophylactic periprocedural antibiotic use was 2.77% [6], suggesting that prophylactic antibiotics were not beneficial and could be harmful. …