Gastroenterological Endoscopy. Группа авторов
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Название: Gastroenterological Endoscopy

Автор: Группа авторов

Издательство: Ingram

Жанр: Медицина

Серия:

isbn: 9783131470133

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СКАЧАТЬ Endoscopy Technology Committee. Mucosal ablation devices. Gastrointest Endosc. 2008; 68(6):1031–1042

      [20] Maple JT, Abu Dayyeh BK, Chauhan SS, et al; ASGE Technology Committee. Endoscopic submucosal dissection. Gastrointest Endosc. 2015; 81(6):1311–1325

      [21] Pannala R, Abu Dayyeh BK, Aslanian HR, et al; ASGE Technology Committee. Per-oral endoscopic myotomy (with video). Gastrointest Endosc. 2016; 83(6):1051–1060

      [22] Parekh PJ, Buerlein RC, Shams R, et al. An update on the management of implanted cardiac devices during electrosurgical procedures. Gastrointest Endosc. 2013; 78(6):836–841

      [23] Nelson G, Morris ML. Electrosurgery in the gastrointestinal suite: knowledge is power. Gastroenterol Nurs. 2015; 38(6):430–439

      [24] Lin OS, Biehl T, Jiranek GC, Kozarek RA. Explosion from argon cautery during proctoileoscopy of a patient with a colectomy. Clin Gastroenterol Hepatol. 2012; 10(10):1176–1178.e2

      [25] Watanabe Y, Kurashima Y, Madani A, et al. Surgeons have knowledge gaps in the safe use of energy devices: a multicenter cross-sectional study. Surg Endosc. 2016; 30(2):588–592

      8 Antibiotic Prophylaxis in Endoscopy

       Mouen A. Khashab and Brooks D. Cash

      8.1 Introduction

      Antibiotic prophylaxis in endoscopy plays a critical role in minimization of infectious complications associated with endoscopic procedures. Although bacteremia is relatively common after both diagnostic and therapeutic procedures, the incidence of infectious endocarditis is very low. Therefore, administration of prophylactic antibiotics solely for the prevention of infectious endocarditis is not recommended for patients undergoing endoscopic procedures. Antibiotic prophylaxis may have an important role in the prevention of infectious complications resulting from certain endoscopic procedures and in specific clinical settings. These include endoscopic retrograde cholangiopancreatography (ERCP) in patients with biliary obstruction and incomplete ductal drainage, ERCP in liver transplant patients, endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of cystic lesions, percutaneous endoscopic gastrostomy (PEG), and endoscopy in cirrhotic patients presenting with gastrointestinal (GI) bleeding, among others.

      Bacterial translocation of GI microbial flora into the bloodstream may occur during endoscopy due to procedure-related trauma. Resulting bacteremia carries a minor risk of localization of infection in distant tissues. In addition, endoscopy may also result in local infections where a typically sterile space or tissue is breached and contaminated by an endoscopic accessory or by contrast injection. In this chapter, infectious complications related to endoscopy and the role of periprocedural antibiotic prophylaxis for the prevention of these complications are presented.

      8.2 Bacteremia Related to Endoscopic Procedures

      Bacteremia can arise following endoscopic procedures and is considered a surrogate marker for infective endocarditis (IE) risk. However, clinically important infections arising from GI endoscopy are uncommon, with only 25 cases of IE reported with temporal association to an endoscopic procedure.1,2,3 Additionally, no data exist that validate a causal association between endoscopic procedures and IE. Likewise, there are no data indicating that antibiotic prophylaxis preceding endoscopic procedures prevents the occurrence of IE.

      8.2.1 Procedures Associated with Low Risk of Bacteremia

      Bacteremia after gastroscopy and colonoscopy occurs in approximately 4% of patients and is not associated with infectious complications.4,5,6 Bacteremia is even uncommon (6.3%) with therapeutic colonic procedures such as colonic stent insertion for colonic obstruction.7

      The frequency of bacteremia after EUS, with or without FNA, is similar to that of upper endoscopy. Prospective studies in patients undergoing EUS-FNA of cystic or solid lesions along the upper GI indicate a bacteremia rate of 4.0 to 5.8%.8,9,10,11 Likewise, EUS-FNA of solid rectal and perirectal lesions is associated with a low risk of bacteremia, with one study reporting a risk of 2%.12

      8.2.2 Procedures Associated with High Risk of Bacteremia

      The highest rates of bacteremia have been reported with esophageal dilation, sclerotherapy of esophageal varices, and ERCP in patients with biliary obstruction. The rate of bacteremia following esophageal dilation ranged between 12 and 22% in three prospective trials,13,14,15 and may be higher with dilation of malignant strictures14 and with passage of multiple dilators.14 The cultured organisms are typically commensal to the mouth. In one study, viridans streptococci was the organism isolated in 79% of cases.13

      The rate of bacteremia associated with variceal sclerotherapy is approximately 15%,16,17,18,19 while that associated with endoscopic variceal ligation is about 9%.20,21,22

      ERCP in patients with a nonobstructed biliary tree is associated with a relatively low rate of bacteremia of 6%, rising to 18% in the setting of biliary obstruction due to stones or tumors.23

      8.3 Antibiotic Prophylaxis for the Prevention of Infective Endocarditis

      The American Heart Association (AHA) recommends that administration of prophylactic antibiotics merely for the prevention of IE is not recommended for patients undergoing GI endoscopic procedures.24 This recommendation is due to the absence of data demonstrating a conclusive link between endoscopic procedures and the development of IE, in addition to a lack of evidence that antibiotic prophylaxis prevents IE following endoscopy.24 Similarly, the American Society for Gastrointestinal Endoscopy (ASGE) recommends against the routine administration of antibiotic prophylaxis solely for prevention of IE.25

      The AHA specifically recognized cardiac conditions associated with the highest risk of poor clinical outcome from IE, including: (1) prosthetic (mechanical or bioprosthetic) cardiac valve; (2) history of previous IE; (3) cardiac transplant recipients who develop cardiac valvulopathy; and (4) patients with congenital heart disease (CHD), including (a) those with unrepaired cyanotic CHD including palliative shunts and conduits, (b) those with completely repaired CHD with prosthetic material or devices, placed surgically or by catheter, for the first 6 months after the procedure, and (c) those with repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or device.24 The AHA suggests administration of antibiotics with coverage of enterococci in patients with these specific cardiac conditions who also have established infections of the GI tract where enterococci may be part of the infecting bacterial flora (such as cholangitis).24 Although resulting infections are likely to be polymicrobial, coverage for enterococci is recommended because only enterococci are likely to result in IE.

      8.3.1 Antibiotic Prophylaxis for the Prevention of Procedural-Related Infections (Other Than IE)

      Antibiotic prophylaxis may have an important role in the prevention of infectious complications resulting from certain endoscopic procedures and in specific clinical settings.

      ERCP

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