Original article
Clinical endoscopy
Use of antimicrobials for EUS-guided FNA of pancreatic cysts: a retrospective, comparative analysis

https://doi.org/10.1016/j.gie.2011.03.1244Get rights and content

Background

Pancreatic cystic lesions present a challenge for patients and physicians alike. Morphology alone is inaccurate in discriminating lesion pathology, and use of EUS-guided FNA (EUS-FNA) improves accuracy. Current American Society for Gastrointestinal Endoscopy guidelines recommend prophylactic antibiotics during FNA of cystic lesions to minimize infection risk. However, evidence pertaining to infection risk has been conflicting. The use of prophylactic antibiotics might not be free of other adverse events and might not prevent infection.

Objective

To assess the impact of antimicrobial therapy for prophylaxis during EUS-FNA of pancreatic cysts.

Patients

This study involved all patients who underwent EUS-FNA of pancreatic cysts at one institution from May 2007 to April 2010.

Intervention

Antibiotic prophylaxis for EUS-FNA.

Main Outcome Measurements

Infection of a pancreatic cyst, fever, or bacteremia after EUS-FNA. Secondary variables included other complications of the procedure related to the use of prophylaxis (ie, allergic reactions, secondary infections).

Results

EUS-FNA was performed on 253 patients in 266 procedures. Antibiotics were used in 88 endoscopy cases (ATB group), whereas no antibiotics were used in 178 cases (NATB group). There were no differences in patient or cyst characteristics between groups. There were 4 major complications in the NATB group (localized bleeding, 2; pancreatitis, 1; bile leakage, 1) and 2 in the ATB group (possible cyst infection, 1; bile leakage, 1) (P = 1.0). Eight mild adverse events were observed in the NATB group and 6 in the ATB group (P = .56). Infections and antibiotic-related complications occurred in 1 (0.6%) (transient fever) in the NATB group and 4 (4.5%) in the ATB group (local allergic reaction, 2; possible cyst infection, 1; Clostridium difficile diarrhea, 1) (P = .04).

Limitations

Retrospective analysis.

Conclusion

The incidence of infectious complications after EUS-FNA of pancreatic cystic lesions, with or without antibiotic prophylaxis, appears very low. We have not observed a protective effect from periprocedural prophylactic antibiotic administration.

Section snippets

Data collection

A retrospective review of all patients who underwent EUS-FNA at the Hospital of the University of Pennsylvania from May 2007 to April 2010 was performed. Standardized data collection sheets were used to extract relevant data from the previous visits at doctors' offices and from endoscopy, radiology, and pathology reports. Patient demographic and clinical data, lesion characteristics, and procedure data were documented. For the analysis of the use of antibiotics before, during, or after the

General description

A total of 317 EUS procedures were performed to evaluate pancreatic cystic lesions. FNA was not performed in 51 cases, based on the size or location of the lesion, the indication, or patient intolerance to the procedure. EUS-FNA was completed in 266 endoscopies on 253 patients (13 patients had repeat EUS-FNA studies between 1 and 3 years after the initial study). Of the procedures included in the study, 97% were performed on an outpatient basis. Fifty-nine percent (157) were performed with

Discussion

Safety of EUS-FNA in solid pancreatic lesions has been demonstrated in previous studies reporting a low incidence of bacteremia.3, 4, 5, 6 Because patients presented no overt symptoms of infection, the use of FNA in solid pancreatic lesions is considered a low-risk procedure for infection and does not warrant prophylaxis. Early in its development, however, a prospective series of 18 patients undergoing EUS-FNA of cystic lesions reported two cases of fever after FNA of pancreatic cysts.7 One

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DISCLOSURE: C. Guarner-Argente received financial support from the Instituto de Salud Carlos III, Government of Spain (BAE grant 2010: BA10-00011) and from the Societat Catalana de Digestologia. No other financial relationships relevant to this publication were disclosed.

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