PROPHYLACTIC ANTIBIOTICS IN THE PREVENTION OF INFECTION IN PATIENTS UNDERGOING ENDOSCOPIC RESECTION OF COLORECTAL LESIONS: A META-ANALYSIS

Aims Larger colorectal lesions tend to have a higher risk of infection after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), possibly because of the larger wound areas. There have been conflicting studies on prophylactic antibiotics in the prevention of infection in patients who underwent EMR or ESD.

Methods A comprehensive literature search from the PubMed Central, Embase, Cochrane Library, and Ovid was performed with the following search terms: prophylaxis, antibiotics, EMR, and ESD. Four studies were selected and validated using the Jadad scale. Trial results were combined under a fixed-effects model. The Cochrane Review Manager Software version 5.0 was used for all analyses. The primary outcome of study was prevention of post-procedural infection as an adverse clinical outcome.

Results Four trials comprising of 850 patients met the inclusion criteria. Three studies were prospective randomized controlled trials while one was a retrospective case control. In the fixed effect model, it showed a statistically significant decrease in the infection rates (p< 0.00001) among patients who were given antibiotic prophylaxis compared to those without (2.9% vs. 26.7% infection rate; OR 0.21, 95% CI: 0.11-0.38). The four trials showed moderate heterogeneity (I²= 36%) since the study by Muro (2015) was of retrospective method. Reconstructing the forest plot analyzing only the prospective studies minimized heterogeneity (I²= 0%).

Conclusions Prophylactic antibiotics given pre- and post-endoscopic resection have shown favorable outcomes in the prevention of infection post-procedure. Nevertheless, further studies on the optimal antibiotic drug class, dosage and duration is recommended.