title: A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct.
abstract: OBJECTIVE
  The frequency of bacteremia during ERCP with cholangioscopy has not been well studied. There are no formal guidelines regarding antibiotic prophylaxis before ERCP with cholangioscopy. The aim was to estimate the frequency of bacteremia and subsequent infectious adverse events after ERCP with cholangioscopy.
  
  
  METHODS
  This prospective nonrandomized study performed in a single tertiary referral center included adult patients who were undergoing ERCP with cholangioscopic examination of the common bile duct. Blood cultures were drawn from patients before the procedure and 5 and 30 minutes after the procedure. Antibiotics were not given before or after the procedure. Patients were followed up after 24 hours and 1 week after the procedure for infectious adverse events. The primary outcome was bacteremia rate, and secondary outcomes were cholangitis rate and adverse events.
  
  
  RESULTS
  Fifty-seven patients were enrolled in the study with 60 procedures performed. The first procedure from each patient was considered in the analysis, and thus we included 57 patients with 57 procedures in this study analysis. Postprocedure bacteremia was seen in 5 of 57 procedures (8.8%; 95% confidence interval, 2.9%-19.3%). Four patients were readmitted with cholangitis (7.0%). Bacteremia was more common in patients who had cholangioscopy with biopsy sampling compared with patients who had cholangioscopy without biopsy sampling (P = .011). Cholangitis was significantly more common in patients with bacteremia than in those patients with a negative blood culture (P = .035).
  
  
  CONCLUSIONS
  ERCP with cholangioscopy is associated with a bacteremia rate of 8.8% and a cholangitis rate of 7.0%. Preprocedural antibiotics may be considered before cholangioscopy, especially if tissue acquisition with biopsy sampling is expected. (
  
  
  BACKGROUND
  NCT01673269.).
authors.affiliation: Gastroenterology and Hepatology Section, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Mohamed O
authors.initials: MO
authors.lastname: Othman
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Guerrero
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Sherif
authors.initials: S
authors.lastname: Elhanafi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Davis
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Jesus
authors.initials: J
authors.lastname: Hernandez
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Houle
authors.affiliation: Division of Biostatistics & Epidemiology, Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Indika
authors.initials: I
authors.lastname: Mallawaarachchi
authors.affiliation: Division of Biostatistics & Epidemiology, Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Alok Kumar
authors.initials: AK
authors.lastname: Dwivedi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Zuckerman
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology*; D001662:Biliary Tract Surgical Procedures; D001706:Biopsy / Q000706:statistics & numerical data*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000453:epidemiology*; D003135:Common Bile Duct / Q000473:pathology / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies