Biopsy increases bacteremia risk after ERCP with cholangiography

SAN DIEGO — Bacteremia development following endoscopic retrograde cholangiography with cholangioscopy was significantly more common with the addition of biopsy in a study presented at the American College of Gastroenterology Annual Scientific Meeting.

In a prospective, nonrandomized single-center study, researchers evaluated 46 patients (56.5% female) who underwent endoscopic retrograde cholangiography (ERCP) with cholangioscopy of the common bile duct (CBD) via the Spyglass system. No participants had used antibiotics within the prior 2 weeks, and none had ongoing infection. Blood cultures were collected immediately prior to ERCP and 5 and 30 minutes after completion, with follow-up for infectious complications at 24 hours and 1 week post-ERCP. Nearly one-quarter (24%) of participants underwent biopsy in addition to cholangioscopy.

No patients had positive cultures prior to ERCP; patients developed bacteremia following the procedure in 13% of cases. Among six patients whose blood cultures at 5 minutes tested positive, one had C. perfringens contamination, while two patients tested positive for E. coli and one patient each had Enterococcus faecium, Enterococcus avium and M. morganii. Two patients had positive cultures at 30 minutes, including one with Staphylococcus capitis contamination; the other was the patient with Enterococcus faecium at the 5-minute evaluation, which persisted at 30 minutes post-ERCP.

Three participants were readmitted for cholangitis, including two with positive cultures at 5 minutes post-ERCP, and one who had negative cultures at 5 and 30 minutes, but K. pneumonia at the 24-hour assessment.

Undergoing biopsy with cholangioscopy was significantly associated with bacteremia rate, with 66.6% of those who received biopsy indicating post-ERCP bacteremia compared with 17.5% of those who did not (P<.023). Age, sex, mean procedure and cholangioscopy time and ERCP for laser lithotripsy were not associated with bacteremia.

“ERCP with cholangioscopy was associated with a bacteremia rate of 13% and a sepsis rate of 6.5%,” researcher Mohamed O. Othman, MD, Texas Tech University Health Sciences Center in El Paso, said here. “The rate of bacteremia was significantly increased with biopsy during cholangioscopy. We recommend that administration of antibiotics should be considered prior to cholangioscopy, especially if tissue acquisition with biopsy is expected.”

Disclosure: The researchers report no relevant financial disclosures.

For more information:

Othman MO. #63: A Prospective Study of the Risk of Bacteremia in Directed Cholangioscopic Examination of Common Bile Duct (CBD). Presented at: The American College of Gastroenterology Annual Scientific Meeting; Oct. 11-16, San Diego.