Abstract
Background
In spite of the weak evidence, antibiotic prophylaxis prior to endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions is routinely used in the clinical practice.
Aims
To compare a group of patients treated with antibiotics before fine-needle aspiration of pancreatic cystic lesions and a group who did not undergo antimicrobial prophylaxis.
Methods
Out of 335 patients with suspected pancreatic cystic lesions referred to our center between 2006 and 2018, after propensity score matching two groups were compared: 135 subjects who underwent endoscopic ultrasound fine-needle aspiration under antibiotic prophylaxis and 135 treated with no antimicrobial agents. Primary outcome was infection rate; secondary endpoints included other complications or antibiotic-related adverse events.
Results
Median age was 64 (interquartile range 61–68) and median cyst size was 24 mm (22–28), with no difference between groups. Overall, 10 adverse events (7.1%) of which 2 serious (1.4%) were observed in the antibiotic group and 8 (5.8%) of which 1 (0.7%) serious in the non-antibiotic group. Cyst infection was observed in 2 patients (1.4%) in the antibiotic group and 3 patients (2.2%) in the other cohort (p = 0.65).
Conclusions
Prophylactic antibiotics do not seem to substantially reduce this risk of infection, and their routine use should be abandoned.
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References
DiMaio CJ. Current guideline controversies in the management of pancreatic cystic neoplasms. Gastrointest Endosc Clin N Am. 2018;28:529–547.
Uribarri-Gonzalez L, Keane MG, Pereira SP, et al. Agreement among Magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI-MRCP) and endoscopic ultrasound (EUS) in the evaluation of morphological features of Branch duct intraductal papillary mucinous neoplasm (BD-IPMN). Pancreatology. 2018;18:170–175.
Do RK, Katz SS, Gollub MJ, et al. Interobserver agreement for detection of malignant features of intraductal papillary mucinous neoplasms of the pancreas on MDCT. AJR Am J Roentgenol. 2014;203:973–979.
van Riet PA, Cahen DL, Poley JW, Bruno MJ. Mapping international practice patterns in EUS-guided tissue sampling: outcome of a global survey. Endosc Int Open. 2016;4:E360–E370.
Zhu H, Jiang F, Zhu J, et al. Assessment of morbidity and mortality associated with endoscopic ultrasound-guided fine-needle aspiration for pancreatic cystic lesions: a systematic review and meta-analysis. Dig Endosc. 2017;29:667–675.
Guarner-Argente C, Shah P, Buchner A, et al. Use of antimicrobials for EUS-guided FNA of pancreatic cysts: a retrospective, comparative analysis. Gastrointest Endosc. 2011;74:81–86.
Polkowski M, Jenssen C, Kaye P, et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European society of gastrointestinal endoscopy (ESGE) technical guideline—March 2017. Endoscopy. 2017;249:989–1006.
ASGE Standards of Practice Committee, Muthusamy VR, Chandrasekhara V, et al. The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. Gastrointest Endosc. 2016;84:1–9.
Facciorusso A, Di Maso M, Barone M, Muscatiello N. Echoendoscopic ethanol ablation of tumor combined to celiac plexus neurolysis improved pain control in a patient with pancreatic adenocarcinoma. Endosc Ultrasound. 2015;4:342–344.
Facciorusso A, Di Maso M, Serviddio G, et al. Echoendoscopic ethanol ablation of tumor combined with celiac plexus neurolysis in patients with pancreatic adenocarcinoma. J Gastroenterol Hepatol. 2017;32:439–445.
Facciorusso A, Martina M, Buccino RV, et al. Diagnostic accuracy of fine-needle aspiration of solid pancreatic lesions guided by endoscopic ultrasound elastography. Ann Gastroenterol. 2018;31:513–518.
National Cancer Institute. Common Terminology Criteria for Adverse Events v4.0 NCI, NIH, DHHS. May 29, 2009 NIH publication # 09-7473. http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf, Accessed October 2018.
Austin PC. A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med. 2008;27:2037–2049.
Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res. 2011;46:399–424.
Facciorusso A, Di Maso M, Antonino M, et al. Polidocanol injection decreases the bleeding rate after colon polypectomy: a propensity score analysis. Gastrointest Endosc. 2015;82:350–358.
Al-Haddad M, Wallace MB, Woodward TA, et al. The safety of fine-needle aspiration guided by endoscopic ultrasound: a prospective study. Endoscopy. 2008;40:204–208.
Klein A, Qi R, Nagubandi S, et al. Single-dose intra-procedural ceftriaxone during endoscopic ultrasound fine-needle aspiration of pancreatic cysts is safe and effective: results from a single tertiary center. Ann Gastroenterol. 2017;30:237–241.
Marinos E, Lee S, Jones B, et al. Outcomes of single-dose peri-procedural antibiotic prophylaxis for endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions. United Eur Gastroenterol J. 2014;2:391–396.
Lim LG, Lakhtakia S, Ang TL, et al. Factors determining diagnostic yield of endoscopic ultrasound guided fine-needle aspiration for pancreatic cystic lesions: a multicentre Asian study. Dig Dis Sci. 2013;58:1751–1757. https://doi.org/10.1007/s10620-012-2528-2
Wiersema MJ, Vilmann P, Giovannini M, et al. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology. 1997;112:1087–1095.
Williams DB, Sahai AV, Aabakken L, et al. Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience. Gut. 1999;44:720–726.
Lee LS, Saltzman JR, Bounds BC, et al. EUS-guided fine needle aspiration of pancreatic cysts: a retrospective analysis of complications and their predictors. Clin Gastroenterol Hepatol. 2005;3:231–236.
Janssen J, Konig K, Knop-Hammad V, et al. Frequency of bacteremia after linear EUS of the upper GI tract with and without FNA. Gastrointest Endosc. 2004;59:339–344.
Tarantino I, Fabbri C, Di Mitri R, et al. Complications of endoscopic ultrasound fine needle aspiration on pancreatic cystic lesions: final results from a large prospective multicenter study. Dig Liver Dis. 2014;46:41–44.
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AF designed the study and performed the statistical analysis; MA and AT collected the data; NM performed the procedures; VRB revised the manuscript. All the authors approved the final draft submitted.
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Facciorusso, A., Buccino, V.R., Turco, A. et al. Antibiotics Do Not Decrease the Rate of Infection After Endoscopic Ultrasound Fine-Needle Aspiration of Pancreatic Cysts. Dig Dis Sci 64, 2308–2315 (2019). https://doi.org/10.1007/s10620-019-05655-x
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DOI: https://doi.org/10.1007/s10620-019-05655-x