Antibiotic Prophylaxis for Patients Undergoing Elective Endoscopic Retrograde Cholangiopancreatography: A Survey of South African Endoscopists and Review of the Literature (General Surgery) (Clinical Report‪)‬

Endoscopic retrograde cholangiopancreatography (ERCP) involves cannulation of the ampulla of Vater and has diagnostic as well as therapeutic capabilities, but the number of non-therapeutic ERCPs is decreasing with time. (1) Endoscopic sphincterotomy, stone extraction and stenting are not without complications. The most widely recognised of these include bleeding, which occurs in 0.7 - 2% of patients, perforation (0.3 - 0.6%), pancreatitis (7%), cholangitis (1%) and cholecystitis (0.2 - 0.5%). Procedure-related mortality is approximately 0.2%. (2) Review of international guidelines regarding the use of prophylactic antibiotics with ERCP shows that routine use of antimicrobials is recommended for biliary obstruction and pancreatic pseudocysts. However, several studies, including a meta-analysis, fail to show any benefit. (3-6) We set out to assess the current antibiotic prescribing practice among South African endoscopists who perform ERCPs, and then review international guidelines and relevant studies.