Clin Endosc.  2022 Nov;55(6):801-809. 10.5946/ce.2021.150.

Is antibiotic prophylaxis necessary after endoscopic ultrasound–guided fine-needle aspiration of pancreatic cysts?

• Hakim S
• Gjeorgjievski M
• Khan Z
• Cannon ME
• Yu K
• Patil P
• DaVee RT
• Guha S
• Badillo R
• Jamil L
• Thosani N
• Ramireddy S

• KMID: 2536081
• DOI: http://doi.org/10.5946/ce.2021.150

Abstract

Background/Aims
Current society guidelines recommend antibiotic prophylaxis for 3 to 5 days after endoscopic ultrasound–guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions (PCLs). The overall quality of the evidence supporting this recommendation is low. In this study, we aimed to assess cyst infection and adverse event rates after EUS-FNA of PCLs among patients treated with or without postprocedural prophylactic antibiotics.
Methods
We retrospectively reviewed all patients who underwent EUS-FNA of PCLs between 2015 and 2019 at two large-volume academic medical centers with different practice patterns of postprocedural antibiotic prophylaxis. Data on patient demographics, cyst characteristics, fine-needle aspiration technique, periprocedural and postprocedural antibiotic prophylaxis, and adverse events were retrospectively extracted.
Results
A total of 470 EUS-FNA procedures were performed by experienced endosonographers for the evaluation of PCLs in 448 patients, 58.7% of whom were women. The mean age was 66.3±12.8 years. The mean cyst size was 25.7±16.9 mm. Postprocedural antibiotics were administered in 274 cases (POSTAB+ group, 58.3%) but not in 196 cases (POSTAB– group, 41.7%). None of the patients in either group developed systemic or localized infection within the 30-day follow-up period. Procedure-related adverse events included mild abdominal pain (8 patients), intra-abdominal hematoma (1 patient), mild pancreatitis (1 patient), and perforation (1 patient). One additional case of pancreatitis was recorded; however, the patient also underwent endoscopic retrograde cholangiopancreatography.
Conclusions
The incidence of infection after EUS-FNA of PCLs is negligible. Routine use of postprocedural antibiotics does not add a significant benefit.

Keyword

Antibiotics; Endoscopic ultrasound; Fine-needle aspiration; Pancreatic cyst; Pancreatic cyst aspiration; Pancreatic cyst infection

Figure

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  Fig. 1. Study flow diagram. EUS-FNA, endoscopic ultrasound–guided fine-needle aspiration; PCLs, pancreatic cystic lesions; POSTAB+, postprocedural antibiotic group; POSTAB–, no postprocedural antibiotic group.

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