IMPACT OF ANTIBIOTIC PROPHYLAXIS AND CONDITIONING MODALITIES DURING THE REALIZATION OF ENDOSCOPIC ORAL MYOTOMY FOR ESOPHAGEAL MOTOR DISORDERS

Aims:

No guidelines regarding antibiotic prophylaxis, preparation and packaging are available in patients with esophageal motor disorders benefiting from per endoscopic oral myotomy (POEM). The main purpose of our study was to evaluate the impact of antibiotic prophylaxis on the POEM's safety.

Methods:

This is a comparative and multicentric retrospective analysis of a database collected prospectively. The data were collected from December 2013 to June 2018 in four French academic hospitals. Patients over 18 year's old with esophageal motor disorders confirmed by prior manometry, who underwent POEM were included. Patients were separated in two groups depending on the presence or absence of antibiotic prophylaxis. The primary endpoint was the occurrence of postoperative complications, as classified by Cotton, based on whether or not antibiotic prophylaxis was administered.

Results:

A total of 226 patients (median age 52.7 ± 19.57 years [18 – 105]) were included. The both groups of patients were comparable in terms of age, sex, BMI, antibiotic therapy administration in the month prior to POEM, pre-treatment, disease severity (pre-POEM Eckardt score), procedure duration, myotomy length and number of clips placed. Intraoperative antibiotic prophylaxis was administered to 170 patients (75.2%) for an average duration of 3.93 ± 3.46 days [1 – 21]. The overall complication rate was 13.8% (n = 31; 5 severe complications according to Cotton's classification). No fatal issues were observed. The use of antibiotic prophylaxis had no impact on the per or postoperatively occurrence (p = 0.809) and severity of complications (p = 0.113). Antibiotic prophylaxis did not influence the effectiveness of the procedure (1,26 ± 1,54 [0 – 9] vs. 1,50 ± 2,06 [0 – 9], p = 0.519).

Conclusions:

The systematic antibiotic prophylaxis during POEM has no impact on the occurrence and severity of complications and the efficacy of the procedure.