A retrospective analysis of the frequency of bacteremia and infectious complications associated with the use of direct peroral cholangiopancreatoscopy during ERCP

Aims To evaluate the risk of bacteraemia following endoscopic retrograde cholangiopancreatography (ERCP) with direct peroral cholangiopancreatoscopy (POCPS). Secondary objectives were to assess the prevalence of other infectious complications and the effect of a "real-life" practices of prophylactic antibiotics administration on these outcomes.

Methods Retrospective analysis of consecutive patients from 2016 to 2022 who underwent POCPS using the SpyGlass System. Prophylactic antibiotic treatment was administered based on clinical discretion. Demographic and clinical data including blood cultures and infectious complications were collected.

Results 75 patients undergoing ERCP with direct POCPS. 63 patients were included in the analysis after excluding 12 patients who were admitted with evidence of bacteraemia and/or biliary infection prior to endoscopic intervention. In 17/63 (27%) patients, post procedural blood cultures were drawn based on clinical suspicion for infection. Positive cultures were found in 4/17 (23.5%) of all cultures and in 4/63 (6.3%) of all cohort, of those 2/63 (3.2%) had clinically significant bacteraemia. Antibiotic prophylaxis was administrated to 35 (55.6%) patients, with no evidence of significant reduction of bacteraemia, cholangitis, hospitalization length or mortality rates when compared with patients who did not receive prophylactic antibiotics (p>0.05). Post procedural cholangitis was observed among 5/63 (7.9%) patients ([Table 1]).

Table 1  

Conclusions The prevalence of bacteraemia and cholangitis following ERCP with direct POCPS was 6.3% and 7.9% cholangitis, respectively. Prophylactic antibiotics did not reduce post procedural infectious adverse events.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
14 April 2023