Department of Surgery, Central Hospital, Växjö, Sweden.
Department of Research and Development, Region Kronoberg, Sweden.
Scand J Gastroenterol. 2021 Mar;56(3):336-341. doi: 10.1080/00365521.2020.1867894. Epub 2021 Jan 5.
Endoscopic retrograde cholangiopancreatography (ERCP) with failed biliary cannulation is associated with a high rate of adverse events, but the role of prophylactic antibiotics remains unclear. The primary aim was to investigate if prophylactically administered antibiotics affect the frequency of overall adverse complications in patients where biliary cannulation fails during ERCP. The secondary aim was to investigate if specific infectious complications, also were affected by the antibiotic prophylaxis.
We analysed data from 96,818 ERCPs (2006-2018), from the Swedish National Quality Registry of Cholecystectomy and ERCP (GallRiks), excluding ERCPs with successful cannulation ( = 88,743), missing data ( = 2,014), or on-going antibiotic therapy ( = 1,062).
In total 4,996 procedures were included, 2,124 received (42.5%) and 2,872 (57.5%) did not receive antibiotic prophylaxis. There were fewer overall complications in the group receiving prophylaxis (13.6% vs. 17.1%, < .001), which corresponded to a 24% adjusted odds reduction in the multivariable analysis (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.65-0.89). In the prophylaxis group, there was a lower overall rate of infectious complications (2.1% vs. 3.2%; = .038; OR 0.68; 95% CI 0.47-0.98) and abscesses (0.8% vs. 1.4%; = .040; OR 0.54; 95% CI 0.31-0.96). However, no significant differences were seen in the rate of cholangitis (1.3% vs. 1.7%; = .182; OR 0.74; 95% CI 0.46-1.18).
This national quality registry study of ERCPs with failed cannulation showed a significant reduction in overall and infectious complications when prophylactic antibiotics were administered.
内镜逆行胰胆管造影（ERCP）中胆管插管失败与较高的不良事件发生率相关，但预防性使用抗生素的作用仍不清楚。主要目的是研究在 ERCP 中胆管插管失败的患者中，预防性使用抗生素是否会影响总体不良并发症的发生频率。次要目的是研究抗生素预防是否也会影响特定的感染性并发症。
我们分析了来自瑞典胆囊切除术和 ERCP 国家质量登记处（GallRiks）的 96818 例 ERCP 数据（2006-2018 年），排除了胆管插管成功（ = 88743）、数据缺失（ = 2014）或正在进行抗生素治疗（ = 1062）的 ERCP。
共有 4996 例手术纳入研究，2124 例（42.5%）接受了抗生素预防，2872 例（57.5%）未接受抗生素预防。预防组的总体并发症较少（13.6%比 17.1%， < .001），多变量分析调整后的优势比（OR）为 0.76（95%置信区间 [CI] 0.65-0.89）。在预防组中，感染性并发症的总体发生率较低（2.1%比 3.2%， = .038；OR 0.68；95% CI 0.47-0.98），脓肿的发生率较低（0.8%比 1.4%， = .040；OR 0.54；95% CI 0.31-0.96）。然而，胆管炎的发生率无显著差异（1.3%比 1.7%， = .182；OR 0.74；95% CI 0.46-1.18）。
这项关于胆管插管失败的 ERCP 的全国质量登记研究表明，预防性使用抗生素可显著降低总体和感染性并发症的发生率。
