P3443 - Is Antibiotic Prophylaxis Warranted in All Patients With Biliary Obstruction Undergoing Endoscopic Retrograde Cholangiopancreatography? A Systematic Review and Meta-Analysis

Eric Smith, MD¹, Yizhong Wu, MD², Colby Adamson, DO¹, Alexander Grieme, DO³, Sanjay Prasad, MD¹, Kim Minh Le, DO⁴, Daryl Ramai, MD, MPH, Msc⁵, Douglas Adler, MD^6
1Baylor Scott & White Medical Center, Round Rock, TX; ²Baylor Scott & White Medical Center, Georgetown, TX; ³Baylor Scott & White Medical Center, Corpus Christi, TX; ⁴Baylor Scott & White Medical Center, Austin, TX; ⁵University of Utah Health, Salt Lake City, UT; ⁶Center for Advanced Therapeutic (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO

Introduction: The use of prophylactic antibiotics before endoscopic retrograde cholangiopancreatography (ERCP) is currently recommended for use only in cases of anticipated incomplete biliary drainage or in patients who are severely immunocompromised. A recent randomized controlled trial (RCT) challenged existing guidelines, which showed a benefit regardless of complete drainage with ERCP. In this systematic review and meta-analysis, we aim to assess whether prophylactic antibiotics improve infectious complication rates after ERCP.

Methods: A systematic search of PubMed, Embase, Cochrane, and Google Scholar was performed from inception to June 2024 for RCTs comparing ERCP outcomes with and without antibiotic prophylaxis. Pooled data was analyzed for the composite outcome of infectious complications including cholangitis, bacteremia, and sepsis. Mortality and pancreatitis were also analyzed. Publication bias was evaluated using funnel plots and regressions for funnel plot asymmetry. Our analysis implemented a dichotomous regression model with random effects using R software.

Results: Our search resulted in a total of 11 RCTs including 2,106 patients, with 1,086 in the antibiotic group and 1,019 in the control group. Age was similar between groups (64.6 vs 64.1 years) and 47.4% of patients included were male. Sphincterotomy and stent placement occurred in 69.1% and 36% of cases respectively. We found significantly lower rates of infectious complications in patients who received antibiotics (RR 0.49, 95% CI: 0.26 to 0.91, p = 0.024, I² = 70%). Including only beta-lactam and cephalosporin antibiotics yielded even higher impact (RR 0.45 CI: 0.2 - 0.85, p = 0.02). Prophylaxis was associated with a significantly lower rate of bacteremia (RR 0.51, CI = 0.28 to 0.92, p = 0.02, I² = 28%). There were no significant differences between groups in terms of cholangitis (p = 0.2) and sepsis (p = 0.07). We found no significant differences in terms of pancreatitis (p=0.5) or mortality (p=0.75). Sensitivity analyses confirmed the robustness of these findings.

Discussion: Our study shows that antibiotic prophylaxis is warranted in all patients with biliary obstruction who are undergoing ERCP.



Disclosures:


Eric Smith, MD¹, Yizhong Wu, MD², Colby Adamson, DO¹, Alexander Grieme, DO³, Sanjay Prasad, MD¹, Kim Minh Le, DO⁴, Daryl Ramai, MD, MPH, Msc⁵, Douglas Adler, MD⁶. P3443 - Is Antibiotic Prophylaxis Warranted in All Patients With Biliary Obstruction Undergoing Endoscopic Retrograde Cholangiopancreatography? A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.