A PROSPECTIVE-STUDY OF SEPTIC COMPLICATIONS OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

Prophylactic antibiotics are used in an attempt to avoid the septic co mplications of endoscopic retrograde cholangiopancreatography (ERCP). Me prospectively performed blood cultures and surveyed patients for co mplications. The aims were first, to determine the incidence of bacter aemia associated with ERCP, second, to assess the incidence of clinica l sepsis following the procedure and third, to evaluate the effectiven ess of our antibiotic prophylaxis. One hundred and fifty successive pa tients underwent 179 ERCP. Bacteraemia related to the procedure or the underlying pathology was found in nine procedures (5.2%). Bacteraemia s were more likely to complicate therapeutic procedures (P = 0.015), b iliary obstruction (P = 0.045) or underlying pathology (P = 0.022).Alt hough 61% of ERCP received antibiotics, 22 septic events occurred. Fiv e bacteraemic patients were septic despite antibiotics. Septic complic ations were associated with the same factors as bacteraemia. It was co ncluded that patients with biliary obstruction and undergoing therapeu tic endoscopic procedures are at greatest risk of bacteraemia. Single dose prophylactic antibiotics may not prevent sepsis in these patients and longer-acting drugs or repeated dosing may be necessary.