Ahmed Elkafrawy, MD
Internal Medicine Resident
University of Missouri-Kansas City
Kansas City, Missouri
Ahmed A. Elkafrawy, MD1, Fredy Nehme, MD2, Mohamed A. Elkhouly, MD, MSc3, Yousaf Zafar, MD2
1University of Missouri Kansas City School of Medicine, Kansas City, MO; 2University of Missouri, Kansas City, MO; 3Cook County Health and Hospital Systems, Chicago, IL
Introduction: EUS guided fine needle aspiration (FNA) of pancreatic cystic lesions (PCL) has become the standard diagnostic modality for pancreatic cysts. Current American Society of Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommended the use of periprocedural prophylactic antibiotics (PA), although data is equivocal. Our aim was to perform a systematic review and meta-analysis to evaluate the efficacy of PA in preventing cyst infection during EUS-guided aspiration of PCL and assess the rate of complications related to antibiotic use.
Methods: We included studies evaluating the outcomes of using PA in EUS-guided FNA of PCL. We searched PubMed, Embase, and Google Scholar through April 2019. Eligible studies were searched for variables of interest including infection of PCL and antibiotic-related complications. All statistical analyses were performed using the R Programming Language. Pooled rates of variables were reported as Relative risks (RR) with 95% confidence interval and heterogeneity was reported as I2 statistics.
Results: A total of 9 retrospective studies were eligible and included in the analysis. 6 studies compared the use of PA to no antibiotics while the other 3 did not have a comparison group. There were 1183 subjects in the antibiotic group and 579 subjects in the non-antibiotic group. Duration of antibiotics varied from a single intraprocedural dose to 3-5 days following the procedure. Multiple antibiotic regimens were used including ceftriaxone, quinolones, amoxicillin, and piperacillin/tazobactam. There was no statistically significant difference in the rate of cyst infection between patients receiving PA and those who did not (RR= 0.6, 0.21-1.75; I2 = 0%) (Figure 1). 1.2% of patients receiving PA developed adverse events related to antibiotic use. In addition, there was no difference among subgroups when stratifying subjects by single dose and 3-5 days of antibiotics (p=0.619) (Figure 2).
Discussion: The incidence of infectious complications after EUS-guided FNA of PCL appears very low and the use of PA did not substantially reduce the risk. Antibiotic use is not free of adverse events. Further randomized controlled trials are needed to evaluate the appropriateness of current recommendations.
Citation: Ahmed A. Elkafrawy, MD; Fredy Nehme, MD; Mohamed A. Elkhouly, MD, MSc; Yousaf Zafar, MD. P0563 - PROPHYLACTIC ANTIBIOTIC ADMINISTRATION IN EUS-GUIDED ASPIRATION OF PANCREATIC CYSTIC LESIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Program No. P0563. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.