Department of Endoscopy Unit, Private Hospital Jean Mermoz, Ramsay Sante, Lyon, France.
Galilee Medical Center, Gastroenterology, Nahariya, Israel, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
J Gastroenterol Hepatol. 2022 Sep;37(9):1685-1692. doi: 10.1111/jgh.15972. Epub 2022 Aug 5.
Antibioprohylaxis (ABP) for pancreatic cystic lesion is still a debated clinical indication. Although professional societies guidelines still recommend ABP in endoscopic ultrasound-fine needle aspiration (EUS-FNA) for pancreatic cystic lesions (PCL), this standard of care recommendation was based on old and weakly planned studies with a small number of patients. Herein, in this work, we provide a critical review with pooled data analysis of the available literature. Overall, the studies reported are weak and limited with small number of patients, the absence of exact definition of infection and the heterogenicity of the type and the duration of the ABP used. Pooled data analysis showed that the effect of ABP on the rate of cyst infection was not significant (OR 0.56, 95% CI 0.17-1.2), with no significant heterogenicity between the results of the studies reviewed and reported (as assessed by Breslow Day test for homogeneity of OR's [P = 0.15]). The pooled infection rate without ABP was 0.89% and 0.36% in the ABP group. Moreover, according to the pooled data infection rate, sample size calculation demonstrated that 6954 patients are needed to show superiority of ABP, with a number needed to treat of 179 patients to prevent single infection. However, through the literature only six studies (1660 patients) reported the cyst infection rate among ABP versus control, making these results scarce and biased by a small number of patients. Therefore, we suggest the need to revise the guidelines, until performing well organized large international study to solve this controversy.
抗菌预防（ABP）在胰腺囊性病变中的应用仍然是一个有争议的临床指征。尽管专业协会指南仍建议在胰腺囊性病变（PCL）的内镜超声细针抽吸（EUS-FNA）中使用 ABP，但这种护理标准的推荐是基于旧的、计划不充分的研究，且这些研究的患者数量较少。在此，我们对现有文献进行了批判性回顾和汇总数据分析。总的来说，所报道的研究都很薄弱且有限，患者数量较少，感染的明确定义缺失，以及所使用的 ABP 的类型和持续时间存在异质性。汇总数据分析显示，ABP 对囊感染率的影响不显著（OR 0.56，95%CI 0.17-1.2），且综述和报道的研究结果之间没有显著的异质性（如 Breslow Day 检验用于评估 OR 的同质性 [P=0.15]）。未使用 ABP 的感染率为 0.89%，使用 ABP 的感染率为 0.36%。此外，根据汇总数据的感染率，样本量计算表明，需要 6954 名患者才能显示 ABP 的优越性，需要治疗 179 名患者才能预防单次感染。然而，通过文献，只有六项研究（1660 名患者）报告了 ABP 与对照组之间的囊感染率，因此这些结果很少，且受到患者数量较少的影响。因此，我们建议有必要修订指南，直到进行组织良好的大型国际研究来解决这一争议。
