title: A randomized controlled trial of prophylactic antibiotics in the prevention of electrocoagulation syndrome after colorectal endoscopic submucosal dissection.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is currently commonly performed, but colorectal ESD has a substantial risk of adverse events, including post-ESD electrocoagulation syndrome (PEECS). We investigated whether the use of prophylactic antibiotics can reduce the occurrence of PEECS.
  
  
  METHODS
  Patients who underwent colorectal ESD were randomly assigned to 1 of 2 treatment regimens. Ampicillin and/or sulbactam mixed with normal saline solution was administered 1 hour before ESD in group 1 then additionally injected every 8 hours twice more. In group 2, normal saline solution without antibiotics was administered following the same schedule. We investigated the characteristics of the patients and tumors, the incidence of PEECS, laboratory findings, and the visual analog scale (VAS) score for abdominal pain measured on the morning after ESD.
  
  
  RESULTS
  A total of 100 cases (50 per group) were finally analyzed, and 97 tumors were successfully resected en bloc. The number of patients having C-reactive protein (CRP) levels ≥1 mg/dL and the number of patients having VAS scores for abdominal pain ≥1 were greater in group 2 than in group 1 (P = .008 and .023, respectively). The incidence of PEECS in group 2 also was higher than that in group 1 (1 and 8 in groups 1 and 2, respectively; P = .031).
  
  
  CONCLUSIONS
  The prophylactic use of ampicillin and/or sulbactam in colorectal ESD is associated with reduced risk of PEECS, decreased CRP levels, and decreased abdominal pain. The use of prophylactic antibiotics in colorectal ESD may be an effective tool for reducing the risk of PEECS. (Clinical trial registration number: KCT0001102.).
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Sang Pyo
authors.initials: SP
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: In-Kyung
authors.initials: IK
authors.lastname: Sung
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Hyung Seok
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Chan Sup
authors.initials: CS
authors.lastname: Shim
authors.affiliation: Division of Infectious Diseases, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Hyun Kyun
authors.initials: HK
authors.lastname: Ki
mesh_terms: D015746:Abdominal Pain / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000667:Ampicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002097:C-Reactive Protein / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000517:prevention & control; D006801:Humans; D007964:Leukocytosis / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010538:Peritonitis / Q000097:blood / Q000517:prevention & control*; D013407:Sulbactam / Q000627:therapeutic use*; D013577:Syndrome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000667:Ampicillin; D002097:C-Reactive Protein; D013407:Sulbactam