ASGE Issues Updated Guidelines on Antibiotic Prophylaxis for GI Endoscopy

OAK BROOK, Ill. – The American Society for Gastrointestinal Endoscopy (ASGE) has issued updated guidelines on antibiotic prophylaxis for gastrointestinal (GI) endoscopy based on the American Heart Association’s (AHA) recently revised guidelines for prophylaxis of infective endocarditis (IE). For endoscopic practice, the administration of prophylactic antibiotics solely to prevent IE is not recommended for patients who undergo GI-tract procedures. The updated ASGE guidelines reflect that change. The guidelines appear in the May issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the ASGE.

The purpose of antibiotic prophylaxis during GI endoscopy is to reduce the risk of significant endogenous infectious complications. The guidelines, prepared by the ASGE Standards of Practice Committee, note that clinically significant infections after endoscopic procedures are extremely rare. Bacteria may enter into the bloodstream during an endoscopy for a variety of reasons, including microscopic tears in the bowel related to the procedure. Endoscopy-related bacteremia carries a small risk of localization of infection in remote tissues (i.e., infective endocarditis, an infection of the lining of the heart cavities and connective tissue). An endoscopy may also result in local infections in which a typically sterile space or tissue is breached and contaminated by an endoscopic accessory or by contrast injection.

"Clinically significant infections from an endoscopic procedure are extremely rare. Despite an estimated 14.2 million colonoscopies and 2.8 million flexible sigmoidoscopies, and perhaps as many upper endoscopies, performed in the United States each year, only approximately 15 cases of IE have been reported, with a temporal association with an endoscopic procedure," said Todd H. Baron, MD, FASGE, chair of the ASGE Standards of Practice Committee. "There are no data that demonstrate a causal link between endoscopic procedures and IE. Similarly, there are no data that demonstrate that antibiotic prophylaxis before endoscopic procedures protects against IE. Based on the AHA’s new recommendations, we have updated our guidelines and no longer recommend antibiotic prophylaxis for GI endoscopic procedures solely to prevent IE."

Other situations during which antibiotic prophylaxis is not warranted include prevention of septic arthritis in patients with prosthetic joints, prevention of graft or device infection in patients with vascular grafts or other nonvalvular cardiovascular devices, and fine needle aspiration of solid lesions along the upper GI tract.

Recommendations for Prevention of Infections Other Than IE Antibiotic prophylaxis may be useful for the prevention of infection related to some endoscopic procedures, before placement of prosthetic devices, and in specific clinical scenarios. Examples of these special situations are prevention of cholangitis after ERCP with incomplete drainage of bile duct obstruction, prevention of pancreatic cyst infection after fine needle aspirate at endoscopic ultrasound or after injection of contrast at ERCP, and prior to placement of a percutaneous feeding tube placement.

ASGE Guidelines
"Antibiotic Prophylaxis for GI Endoscopy" can be accessed at: http://asge.org/WorkArea/showcontent.aspx?id=4298

"Infection Control During GI Endoscopy" is available at: http://asge.org/WorkArea/showcontent.aspx?id=4300

"Multi-Society Guidelines for Reprocessing Flexible Gastrointestinal Endoscopes" can be accessed at: http://asge.org/WorkArea/showcontent.aspx?id=3376

Source: American Society for Gastrointestinal Endoscopy (ASGE)