Randomized Trial of Prophylactic Antibiotics for Endoscopic Retrograde Cholangiopancreatography in Patients With Biliary Obstruction

Clinical application of fly-thru in diagnosis of biliary obstructive diseases: feasibility, reproducibility, and diagnostic value

PURPOSE

To evaluate the feasibility, reproducibility, and diagnostic value in biliary obstructive diseases using Fly-Thru (FT) technique.

METHODS

In this single-center prospective study, patients with biliary obstruction who underwent both abdominal ultrasound and FT examinations were recruited between January 2013 and January 2023. 3D FT images (3D-FT) were reconstructed with FT volumetric data. Image quality was subjectively assessed by two radiologists independently. 3D-FT was used to determine the degree of biliary obstruction and compared with ultrasound-guided percutaneous transhepatic cholangiography (PTC). Diagnostic confidence level, diagnostic accuracy and diagnostic duration of the two radiologists using 2D-ultrasound (2D-US) alone and 2D-US combined with 3D-FT were recorded respectively and compared.

RESULTS

100 consecutive patients were enrolled (mean age: 59.6 ± 13.2 years; 52 men). All 3D-FT images were successfully reconstructed and most (75% and 66%) 3D-FT images were considered clear and highly useful for diagnosis with a good agreement (Kappa = 0.653). Benign lesions and malignancies presented differently in both 2D-US and 3D-FT imaging. 3D-FT was not inferior to PTC in determining the degree of biliary obstruction (p = 0.101), with the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and positive predictive value as 90.5%, 26.7%, 1.23, 0.36, 77.6%, 50.0% respectively. Combined with 2D-US, 3D-FT significantly increased the diagnostic confidence level and diagnostic accuracy of biliary obstructive diseases (all p < 0.01), especially for radiologists with less experience.

CONCLUSION

Application of 3D-FT in diagnosis of biliary obstructive diseases was considered feasible and reproducible, with satisfactory diagnostic value and clinical importance.

Prevention of Bacterial Infection in Biliary and Pancreatic Endoscopy-A Review

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is a key therapeutic procedure in diseases of the pancreas or bile ducts. The understanding and effective management of the risks associated with the procedure, especially in the context of possible infectious complications, is crucial for patients' safety. The aim of this review was to analyze the results of studies on antibiotic prophylaxis for infectious complications of ERCP, pancreatoscopy, and cholangioscopy.

METHODS

This study is a review of the articles available in PubMed, Medline, and Embase published in the last 30 years.

RESULTS

Nineteen studies and six sets of guidelines on antibiotic prophylaxis before ERCP were retrieved.

CONCLUSIONS

Based on the available studies and recommendations, it can be concluded that antibiotic prophylaxis before ERCP is beneficial for immunocompromised patients or those at risk of bacterial endocarditis. In other groups of patients, antibiotic prophylaxis reduces the risk post-ERCP bacteremia but does not significantly reduce the risk of cholangitis and infectious complications. The effectiveness of antibiotic prophylaxis in patients at risk of incomplete biliary drainage needs to be verified in further studies.