Meta-analysis of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography (ERCP)

Background and Study Aims: Considerable controversy exists regarding the ro le of antibiotic prophylaxis prior to endoscopic retrograde cholangiopancre atography (ERCP), in that various studies of antibiotic prophylaxis have re ached conflicting conclusions. The aim of this meta-analysis is to synthesi ze the data in order to determine whether antibiotic prophylaxis reduces th e rate of occurrence of bacteremia and/or the rate of seosus/cholangitis am ong patients undergoing ERCP. Patients and Methods: Clinical trials were selected via Medline and Pubmed using subject words and textwords "ERCP", "antibiotic" and "antibiotic prop hylaxis". Summary estimates of the risk ratios for the outcomes of bacterem ia and sepsis/cholangitis were calculated. Results: After 49 abstracts had been reviewed, seven randomized placebo-con trolled trials of antibiotic prophylaxis prior to ERCP were identified. Upo n further review; two studies were excluded because patients received antib iotics before and after the ERCP. Four studies reported on the clinical out come of bacteremia. Five studies reported on the clinical outcome of sepsis /cholangitis, The summary relative risk of the association between antibiot ic prophylaxis and bacteremia was 0.39 (95% Cl, 0.12-1.29), For sepsis/chol angitis the summary relative risk was 0.91 (95 % CI, 0.39-2.15), Conclusions: Antibiotic prophylaxis prior to ERCP may reduce the incidence of bacteremia but this has little clinical relevance. Prophylaxis does not substantially reduce the incidence of sepsis/cholangitis and thus the routi ne use of antibiotic prophylaxis cannot be recommended.