Guidelines for Antibiotic Prophylaxis for GI Endoscopy

doi:10.1067/S0016-5107(03)01883-2

Gastrointestinal Endoscopy

Volume 58, Issue 4, October 2003, Pages 475-482

https://doi.org/10.1067/S0016-5107(03)01883-2 Get rights and content

Abstract

This is one of a series of statements discussing the utilization of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts.

Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.

Section snippets

GI Endoscopy and the Risk of Infectious Complications

The role of antibiotic prophylaxis is to reduce the possibility of a significant infectious complication. Randomized, double-blind, placebo-controlled trials, however, will likely never be performed. What can be extrapolated from the literature is the number of reports of infectious complications and the incidence of bacteremia associated with common endoscopic procedures. This review updates the 1995 ASGE guideline on this subject.¹

Despite the large number of endoscopic procedures performed

Prophylaxis Against Infective Endocarditis

Cardiac lesions proposed to be at high risk for the development of infective endocarditis include the following⁵⁴: prosthetic cardiac valves, including bioprosthetic and homograft valves; previous bacterial endocarditis; surgically constructed systemic pulmonary shunts or conduits; complex cyanotic congenital heart disease (e.g., single ventricle states, transposition of the great arteries, tetralogy of Fallot).

Cardiac lesions or conditions that do not confer an increased risk of endocarditis

Summary

For the following points:(A), Prospective controlled trials; (B), observational studies; (C), expert opinion.

•
Antibiotic prophylaxis against infective endocarditis is recommended when a high-risk patient is undergoing an endoscopic procedure associated with a high incidence for transient bacteremia. (C)
•
Patients undergoing high-risk endoscopic procedures who have a synthetic vascular graft less than 1 year old also should receive antibiotic prophylaxis. (C)
•
There is no clear benefit or consensus

References (114)

W Rumfeld et al.
Bacterial endocarditis after endoscopy
Lancet
(1980)
Y Niv et al.
Bacterial endocarditis after Hurst bougienage in a patient with benign esophageal stricture and mitral valve prolapse
Gastrointest Endosc
(1985)
C Watanakunakorn
Streptococcus bovisendocarditis associated with villous adenoma following colonoscopy
Am Heart J
(1988)
TM Pritchard et al.
Prosthetic valve endocarditis due to Cardiobacterium hominisoccurring after upper gastrointestinal endoscopy
Am J Med
(1991)
GS Breuer et al.
Infective endocarditis associated with upper endoscopy
J Infect
(1998)
M Montalto et al.
Mitral valve endocarditis caused by Streptococcus oralis occurring after upper gastrointestinal endoscopy
Am J Gastroenterol
(2002)
DB Nelson
Infectious disease complications of gastrointestinal endoscopy
Part I: endogenous infections. Gastrointest Endosc
(2003)
VA Botoman et al.
Bacteremia with gastrointestinal endoscopic procedures
Gastrointest Endosc
(1986)
DR Raines et al.
The occurrence of bacteremia after esophageal dilation
Gastrointest Endosc
(1975)
LB Cohen et al.
Bacteremia after endoscopic injection sclerosis
Gastrointest Endosc.
(1983)

CM Brayko et al.

Bacteremia during esophageal variceal sclerotherapy: its cause and prevention

Gastrointest Endosc

(1985)

H Snady et al.

The relationship of bacteremia to the length of injection needle in endoscopic variceal sclerotherapy

Gastrointest Endosc

(1985)

G Zuccaro et al.

Viridans streptococcal bacteremia after esophageal stricture dilation

Gastrointest Endosc

(1998)

DB Nelson et al.

Bacteremia with esophageal dilation

Gastrointest Endosc

(1998)

WK Hirota et al.

The effect of oral decontamination with clindamycin palmitate on the incidence of bacteremia after esophageal dilation

A prospective trial. Gastrointest Endosc

(1999)

G Lo et al.

A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices

Gastrointest Endosc

(1994)

G Lo et al.

A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices

Hepatology

(1995)

C Tseng et al.

Bacteremia after endoscopic band ligation of esophageal varices

Gastrointest Endosc

(1992)

OS Lin et al.

Bacterial peritonitis after elective endoscopic variceal ligation: a prospective study

Am J Gastroenterol

(2000)

J Llach et al.

Prospective assessment of the risk of bacteremia in cirrhotic patients undergoing lower intestinal endoscopy

Gastrointest Endosc

(1999)

WS Selby et al.

Bacteremia and bacterascites after endoscopic sclerotherapy for bleeding esophageal varices and prevention by intravenous cefotaxime: a randomized trial

Gastrointest Endosc

(1994)

JTM VanDermeer et al.

Efficacy of antibiotic prophylaxis for prevention of native-endocarditis

Lancet

(1992)

GW Meyer

Prophylaxis of infective endocarditis during gastrointestinal procedures: report of a survey

Gastrointest Endosc

(1979)

RG Brooks et al.

Hospital survey of antimicrobial prophylaxis to prevent endocarditis in patients with prosthetic heart valves

Am J Med

(1988)

NA Scott et al.

Pyogenic arthritis of the knee following Nd: YAG laser destruction of an esophageal cancer

Gastrointest Endosc

(1990)

DS Zimmon et al.

Complications of endoscopic retrograde cholangiopancreatography: analysis of 300 consecutive cases

Gastroenterology

(1975)

MK Bilbao et al.

Complications of endoscopic retrograde cholangiopancreatography (ERCP): a study of 10,000 cases

Gastroenterology

(1976)

PB Cotton et al.

Endoscopic sphincterotomy complications and their management: an attempt at consensus

Gastrointest Endosc

(1991)

S Loperfido et al.

Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study

Gastrointest Endosc

(1998)

E Masci et al.

Complications of diagnostic and therapeutic ERCP: a prospective multicenter study

Am J Gastroenterol

(2001)

EC Lai et al.

Urgent biliary decompression after endoscopic retrograde cholangiopancreatogaphy

Am J Surg

(1989)

C Niederau et al.

Prophylactic antibiotic treatment in therapeutic or complicated diagnostic ERCP: results of a randomized, controlled study

Gastrointest Endosc

(1994)

M Barawi et al.

A prospective evaluation of the incidence of bacteremia associated with EUS-guided fine-needle aspiration

Gastrointest Endosc

(2001)

MJ Wiersema et al.

Endosonography guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment

Gastroenterology

(1997)

H Panigrahi et al.

Role of antibiotic prophylaxis for wound infection in percutaneous endoscopic gastrostomy (PEG): result of a prospective double-blind randomized controlled trial

J Hosp Infect

(2002)

AJ Dormann et al.

A single dose of ceftriaxone administered 30 minutes before percutaneous endoscopic gastrostomy significantly reduces local and systemic infective complications

Am J Gastroenterol

(1999)

V Sharma et al.

Meta-analysis of randomized, controlled trials of antibiotic prophylaxis before percutaneous endoscopic gastrostomy

Am J Gastroenterol

(2000)

J de la Pena et al.

Variceal ligation compared with endoscopic sclerotherapy for variceal hemorrhage: prospective randomized trial

Gastrointest Endosc

(1999)

M Deschenes et al.

Risk factors for the development of bacterial infections in hospitalized patients with cirrhosis

Am J Gastroenterol

(1999)

M Umehara et al.

Sclerotherapy plus ligation versus ligation for the treatment of esophageal varices: a prospective randomized study

Gastrointest Endosc

(1999)

I Al Traif et al.

Randomized trial of ligation versus combined ligation and sclerotherapy for bleeding esophageal varices

Gastrointest Endosc

(1999)

WC Chen et al.

Bacteremia after endoscopic injection of N-butyl-2-cyanoacrylate for gastric variceal bleeding

Gastrointest Endosc

(2001)

ASGE

Antibiotic prophylaxis for gastrointestinal endoscopy

Gastrointest Endosc

(1995)

PJ Shorvon et al.

Gastrointestinal instrumentation, bacteremia, and endocarditis

Gut

(1983)

TP Yin et al.

Bacterial endocarditis after Hurst bougienage in a patient with a benign oesophageal stricture

Endoscopy

(1983)

W Rodriguez et al.

Enterococcal endocarditis following flexible sigmoidoscopy

West J Med

(1984)

JL Murray

Enterococcal endocarditis after sigmoidoscopy

West J Med

(1984)

J Rigilano et al.

Enterococcal endocarditis following sigmoidoscopy and mitral valve prolapse

Arch Intern Med

(1984)

RF Logan et al.

Bacterial endocarditis: a complication of gastroscopy

Br Med J

(1988)

G Baskin

Prosthetic endocarditis after endoscopic variceal sclerotherapy: a failure of antibiotic prophylaxis

Am J Gastroenterol

(1989)

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2020, Pediatric Gastrointestinal and Liver Disease, Sixth Edition
Endoscopic retrograde cholangiopancreatography (ERCP) is widely performed in adult patients, less commonly in pediatric patients. ERCP in children can have unique indications, procedural considerations, technical approaches, and follow-up plans when compared to adult ERCP. This chapter will review the indications, technique, interpretation, risks, adverse events, and outcomes of ERCP in a pediatric population.
Invasive Procedures Associated With the Development of Infective Endocarditis
2018, Journal of the American College of Cardiology
Various invasive medical procedures might induce bacteremia and, hence, act as triggers for infective endocarditis. However, empirical data in humans on the potential dangers of invasive medical procedures in this regard are very sparse. Due to lack of sufficient data, it is currently debated whether the risk for endocarditis with medical procedures is substantial or rather negligible.
The purpose of this nationwide case-crossover study was to quantify the excess risk for infective endocarditis in association with invasive medical and surgical procedures.
The authors identified all adult patients treated for endocarditis in hospitals in Sweden between January 1, 1998, and December 31, 2011. The authors applied a case-crossover design and compared the occurrence of invasive medical procedures 12 weeks before endocarditis with a corresponding 12-week time period exactly 1 year earlier. The authors considered all invasive nondental medical procedures except for those that are likely to be undertaken due to endocarditis or sepsis or due to infections that could possibly lead to endocarditis.
The authors identified 7,013 cases of infective endocarditis during the study period. Among others, several cardiovascular procedures, especially coronary artery bypass grafting; procedures of the skin and management of wounds; transfusion; dialysis; bone marrow puncture; and some endoscopies, particularly bronchoscopy, were strongly associated with an increased risk for infective endocarditis.
This study suggests that several invasive nondental medical procedures are associated with a markedly increased risk for infective endocarditis.
Quality Issues and Measures in ERCP
2018, ERCP, Third Edition
Quality metrics and measures have become common in medicine. ERCP has the highest adverse events rate among endoscopic procedures and requires substantial endoscopic skill. Gastointestinal societies, including the American Society for Gastrointesinal Endoscopy (ASGE) and the American College of Gastroenterology (ACG), have responded by developing quality indicators for ERCP. These indicators include process and outcome measures and can be used to measure and drive quality improvement in ERCP both for institutions and individuals. These can be divided into preprocedure, intraprocedure, and postprocedures timeframes and will be discussed in this chapter.
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Endoscopic Ultrasound (EUS) provides the unique opportunity to visualize, interrogate and intervene gastrointestinal (GI) luminal, mural or peri-luminal structures and pathology with negligible adverse effects. Diagnostic, upper GI and rectal EUS is feasible, extremely safe, and efficacious. Most EUS guided interventions are safe, effective and minimally invasive, compared to peers in the percutaneous radiological or surgical procedures.
As with any endoscopic procedure, EUS and its guided interventions may be accompanied by adverse events. EUS related complications are generally infrequent in expert hands, and mainly include bleeding and perforation. However, the nature and severity of adverse events associated with each EUS guided procedure are unique. Hence, it is paramount for endosonographer to have sufficient knowledge of the indications, techniques, and potential risks involved before contemplating any given procedure.
Most common intervention with EUS is transmural fine needle aspiration (FNA), which is an extremely safe procedure. EUS guided drainage procedures are rapidly evolving with newer devices and methods being employed. Among them, EUS guided drainage of pancreatic fluid collection-pseudocyst or walled off necrosis (WON), has largely replaced other methods (surgical, percutaneous or non-EUS endoscopic) with acceptable complications. Currently, dedicated metal stents are more widely used compared to plastic stents for drainage of PFC, especially WON. EUS has made a definite impact in biliary access and drainage of obstructed biliary system, in patients where ERCP has failed or is technically not possible, closely competing with percutaneous biliary drainage. In spite of some complications, recent improvement in devices for bilio-enteric fistula creation and stent designs, has added to its safety and efficacy. EUS guided pancreatic duct drainage remains the most challenging of EUS guided interventions where in-roads are being made.
Outcomes of ERCP in Billroth II gastrectomy patients
2016, Gastrointestinal Endoscopy
ERCP is a difficult procedure to perform in Billroth II gastrectomy patients because of altered anatomy. We investigated the outcomes and risk factors for adverse events with ERCP using a cap-fitted forward-viewing endoscope with endoscopic papillary balloon dilation (EPBD) in Billroth II gastrectomy patients.
The records for Billroth II gastrectomy patients who underwent ERCP using a cap-fitted forward-viewing endoscope with EPBD at 5 institutions between August 2008 and April 2014 were retrospectively reviewed. The outcomes and risk factors for adverse events resulting from this treatment were analyzed.
In total, 165 patients were identified. ERCP was technically successful in 144 patients (87.3%) and clinically successful in 141 patients (85.5%). Adverse events occurred in 38 patients (23.0%): perforation in 3 cases (1.8%), pancreatitis in 13 cases (7.9%), and asymptomatic hyperamylasemia in 22 patients (13.3%). In univariate analysis, ≥2 ERCP sessions, periampullary diverticulum, and common bile duct (CBD) stone size ≥ 12 mm were found to be associated with ERCP-related adverse events. In multivariate analysis, ≥2 ERCP sessions (odds ratio [OR], 4.762; 95% confidence interval [CI], 1.472-15.402; P = .009) and a CBD stone size ≥ 12 mm (OR, 3.213; 95% CI, 1.140-9.057; P = .027) were significant.
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View all citing articles on Scopus

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GuidelinesGuidelines for Antibiotic Prophylaxis for GI Endoscopy

Abstract

Section snippets

GI Endoscopy and the Risk of Infectious Complications

Prophylaxis Against Infective Endocarditis

Summary

Lancet

Gastrointest Endosc

Am Heart J

Am J Med

J Infect

Am J Gastroenterol

Part I: endogenous infections. Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc.

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

A prospective trial. Gastrointest Endosc

Gastrointest Endosc

Hepatology

Gastrointest Endosc

Am J Gastroenterol

Gastrointest Endosc

Gastrointest Endosc

Lancet

Gastrointest Endosc

Am J Med

Gastrointest Endosc

Gastroenterology

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Am J Gastroenterol

Am J Surg

Gastrointest Endosc

Gastrointest Endosc

Gastroenterology

J Hosp Infect

Am J Gastroenterol

Am J Gastroenterol

Gastrointest Endosc

Am J Gastroenterol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Antibiotic prophylaxis for gastrointestinal endoscopy

Gastrointest Endosc

Gastrointestinal instrumentation, bacteremia, and endocarditis

Gut

Bacterial endocarditis after Hurst bougienage in a patient with a benign oesophageal stricture

Endoscopy

Enterococcal endocarditis following flexible sigmoidoscopy

West J Med

Enterococcal endocarditis after sigmoidoscopy

West J Med

Enterococcal endocarditis following sigmoidoscopy and mitral valve prolapse

Arch Intern Med

Bacterial endocarditis: a complication of gastroscopy

Br Med J

Prosthetic endocarditis after endoscopic variceal sclerotherapy: a failure of antibiotic prophylaxis

Am J Gastroenterol

Guidelines
Guidelines for Antibiotic Prophylaxis for GI Endoscopy