Antibiotics Reduce Infectious Complications in Patients After ERCP for Distal Malignant Biliary Obstruction

Antibiotic stewardship has led to a significant reduction in antibiotic use during ERCP. Specifically, antibiotics are recommended only for some high-risk patients, such as those at risk of incomplete drainage after ERCP (eg, primary sclerosing cholangitis or complex hilar stricture), those who have undergone cholangioscopy, and those who are immunocompromised. However, recent data have suggested a broader benefit of antibiotics.

In this retrospective cohort study performed at 5 centers, researchers identified patients with distal malignant biliary obstruction; those with prior cholecystectomy were excluded. The primary outcome was the development of a post-ERCP infectious event, especially cholecystitis or cholangitis.

Of 508 patients, 304 received peri-ERCP antibiotics, and 204 did not. Two propensity-score matched cohorts were identified, with 165 patients selected for each group. In these matched cohorts, the post-ERCP infectious risk was significantly lower in the antibiotic group (3.6%) than in the nonantibiotic group (10.3%), with a number needed to treat of 14.9. There was a significant reduction in post-ERCP cholangitis rates, but not in cholecystitis.