Is Antibiotic Prophylaxis Necessary During EUS-FNA of Pancreatic Cystic Lesions?

Risk of infection is low in patients undergoing endoscopic ultrasound with fine-needle aspiration (EUS-FNA) of pancreatic cysts, researchers report from a randomized controlled trial published in Gastroenterology. The incidence of infections did not differ significantly with vs without ciprofloxacin prophylaxis.

The risk of pancreatic cyst infection after EUS-FNA is not known, and it is not clear whether antibiotic prophylaxis reduces the incidence of infections. Juan Colán-Hernández et al conducted a randomized trial to evaluate the efficacy of antibiotic prophylaxis to prevent infection after an EUS-FNA of a pancreatic cystic lesion.

In the study, patients undergoing EUS-FNA of cystic lesions were randomly assigned to groups that received the prophylaxis with ciprofloxacin (n = 112) or saline solution (n = 114, placebo). Patients were observed for 21 days for FNA-related infections.

The only case of FNA-related infection (0.44%) occurred in a patient in the placebo group (0.87%); this patient developed acute pancreatitis and bacteremia after the procedure. Prevention of infection was not inferior in the control group (the difference between proportions was 0.87%; 95% CI, -0.84% to 2.59%). There were no differences between groups in fever (2 patients in each group: 1.78% vs 1.76%; P = 1.00) or other adverse events.

 The most common incidences were abdominal discomfort (17 cases) and diarrhea (14 cases), which did not differ significantly between groups.

The authors conclude that there is a low risk of infection during EUS-FNA of pancreatic cysts and that risk does not increase without antibiotic prophylaxis. These results might lead to changes in recommendations in guidelines, and help avoid unnecessary antibiotic use, which contributes to resistance and other undesired effects.

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