Antibiotics Are Not Necessary to Prevent Pancreatic Cyst Infection After Endoscopic Ultrasound-Guided Fine-Needle Aspiration
Vanessa M. Shami, MD, FASGE, reviewing Hernández JC, et al. Gastroenterology 2020 Jan 20.
The European Society of Gastrointestinal Endoscopy recommends routine antibiotic prophylaxis for patients undergoing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatitis cysts (low-level evidence, weak recommendation). With the risk of pancreatic cyst infection after EUS-FNA largely unknown, this multicenter, randomized, noninferiority study investigated how antimicrobial prophylaxis influences the incidence of infection after EUS-FNA.
Patients were recruited from September 2014 to June 2018 and randomly assigned to receive prophylaxis with ciprofloxacin (n=112) or saline solution (n=114). There were no significant differences in demographics or baseline data between the groups. Individuals were followed for 21 days after EUS-FNA, with a primary outcome of infection and secondary outcomes of fever, procedure complications, and medication-related events. Of the 205 patients who completed the trial (90.7%), there was only 1 case of FNA-related infection with acute pancreatitis in the placebo group (0.87%). There were no significant differences in the incidence of infection, fever, or other events between the groups.
Comment:
The risk of pancreatic cyst infection after EUS-FNA has conflicting data, with previous studies ranging between 1% and 9%. This is the first randomized trial to demonstrate that prophylaxis is not indicated in this patient population. Moreover, this approach can also help mitigate adverse events of antibiotic use, which includes diarrhea, antibiotic resistance, or allergic reactions. Ultimately, this study should influence the clinical approach to EUS-FNA and alter societal recommendations.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Vanessa M. Shami, MD, FASGE
Citation(s):
Hernández JC, Sendino O, Loras C, et al. Antibiotic prophylaxis not required for endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions, based on a randomized trial. Gastroenterology 2020 Jan 20. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2020.01.025)
