Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Gastrointest Endosc. 2011 Jul;74(1):81-6. doi: 10.1016/j.gie.2011.03.1244.
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.
To assess the impact of antimicrobial therapy for prophylaxis during EUS-FNA of pancreatic cysts.
Retrospective cohort study.
This study involved all patients who underwent EUS-FNA of pancreatic cysts at one institution from May 2007 to April 2010.
Antibiotic prophylaxis for EUS-FNA.
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).
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).
Retrospective analysis.
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.
胰腺囊性病变对患者和医生来说都是一个挑战。仅凭形态学无法准确区分病变的病理，而 EUS-FNA（超声内镜引导下细针抽吸）的应用则提高了准确性。目前，美国胃肠内镜学会指南建议在 FNA 时预防性使用抗生素，以降低感染风险。然而，有关感染风险的证据一直存在争议。预防性使用抗生素可能并非没有其他不良反应，也不能预防感染。
评估在 EUS-FNA 胰腺囊肿时使用抗生素进行预防治疗的影响。
回顾性队列研究。
本研究纳入了 2007 年 5 月至 2010 年 4 月在一家机构接受 EUS-FNA 胰腺囊肿的所有患者。
EUS-FNA 时使用抗生素预防。
EUS-FNA 后胰腺囊肿感染、发热或菌血症。次要变量包括与预防使用相关的操作其他并发症（即过敏反应、继发感染）。
在 253 例患者的 266 例操作中进行了 EUS-FNA。88 例内镜病例中使用了抗生素（ATB 组），而 178 例未使用抗生素（NATB 组）。两组患者或囊肿特征无差异。NATB 组有 4 例主要并发症（局部出血 2 例，胰腺炎 1 例，胆漏 1 例），ATB 组有 2 例（可能的囊肿感染 1 例，胆漏 1 例）（P=1.0）。NATB 组观察到 8 例轻度不良事件，ATB 组观察到 6 例（P=0.56）。NATB 组有 1 例（0.6%）（短暂发热）发生感染和抗生素相关并发症，ATB 组有 4 例（4.5%）（局部过敏反应 2 例，可能的囊肿感染 1 例，艰难梭菌腹泻 1 例）（P=0.04）。
回顾性分析。
EUS-FNA 胰腺囊性病变后感染性并发症的发生率，无论是否使用抗生素预防，似乎都非常低。我们没有观察到围手术期预防性使用抗生素的保护作用。
