Patient group | Procedures that require prophylaxis | Comments* |
Specific patient groups | ||
Patients with cirrhosis and acute GI bleeding | All endoscopic procedures | Patients with cirrhosis and acute GI bleeding require antibiotics as part of their routine treatment, even if they are not undergoing an endoscopic examination. |
Cirrhosis with ascites | Procedures that are high risk for infection or bacteremia¶ | Studies supporting using prophylactic antibiotics in patients with cirrhosis and ascites are lacking. We believe it is prudent to provide prophylaxis in this group of patients, given the risk of bacterial translocation. |
Severe neutropenia (ANC <500 cells/mm3) Advanced hematologic malignancy | Procedures that are high risk for infection or bacteremia¶ | Studies supporting using prophylactic antibiotics in patients at increased risk for infection are lacking. We believe it is prudent to provide prophylaxis in this group of patients, given their increased risk for infection. Prophylaxis is not recommended for patients who are immunocompromised for other reasons. |
Synthetic vascular grafts within six months of graft placement | Procedures that are high risk for infection or bacteremia¶ | When possible, elective procedures should be performed before a synthetic graft is placed or delayed for six months following graft placement. If a procedure is necessary within six months of graft placement, we generally will give antibiotic prophylaxis for high-risk procedures. |
Procedure | Patients/conditions that require prophylaxis | Comments* |
For patients NOT falling into one of the above mentioned groups | ||
Upper endoscopy | ||
| None | |
| All patients | The ASGE guidelines recommend pre-procedural screening for MRSA in areas where MRSA is endemic and attempting decontamination before placing the feeding tube. |
Colonoscopy or flexible sigmoidoscopy, with or without biopsy or polypectomy | None | Patients undergoing peritoneal dialysis should have the procedure done with the peritoneum empty. However, this recommendation differs from that of the ASGE, which recommends antibiotic prophylaxis for patients undergoing peritoneal dialysis prior to lower GI endoscopy, and the ISPD, which recommends antibiotic prophylaxis for patients undergoing colonoscopy with polypectomy. |
ERCP | Cholangitis Biliary obstruction without cholangitis if complete drainage is unlikely (eg, in patients with malignant hilar carcinoma or primary sclerosing cholangitis) Biliary complications following liver transplantation if drainage is unlikely | Patients with cholangitis should receive antibiotics as part of their routine treatment. Additional prophylaxis is not required. If drainage is not successful, antibiotics should be started. Once drainage has been established, antibiotics can be discontinued if there is no cholangitis. |
EUS-FNA of cystic lesions | Mediastinal cysts | The ASGE recommends antibiotic prophylaxis for all patients undergoing EUS-FNA of cystic lesions. However, we reserve it for patients with mediastinal cysts since they appear to be at increased risk of infection. We do not provide antibiotic prophylaxis for EUS-FNA of pancreatic cysts because there are insufficient data to support their use in this setting. Antibiotics are typically continued for three to five days after the procedure. |
EUS-FNA of solid lesions along the GI tract | None | |
Interventional EUS proceduresΔ, natural orifice transluminal endoscopic surgery (NOTES) | All patients |
GI: gastrointestinal; ANC: absolute neutrophil count; AHA: American Heart Association; ASGE: American Society for Gastrointestinal Endoscopy; PEG: percutaneous endoscopic gastrostomy; PEJ: percutaneous endoscopic jejunostomy; MRSA: methicillin-resistant Staphylococcus aureus; ISPD: the International Society for Peritoneal Dialysis; ERCP: endoscopic retrograde cholangiopancreatography; EUS: endoscopic ultrasound; FNA: fine-needle aspiration.
* The recommendations in this table are generally consistent with guidelines from the ASGE and AHA except as noted here.
¶ Procedures that are high risk for bacteremia or infection include dilation of esophageal strictures, endoscopic sclerotherapy, ERCP, EUS-FNA, and PEG/PEJ tube placement.
Δ Interventional EUS procedures include drainage of walled-off pancreatic necrosis, biliary drainage, and fine-needle injection of cysts/tumors.Do you want to add Medilib to your home screen?