Gastroenterology and Hepatology


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Antibiotic Prophylaxis In Endoscopy:

Translocation of bacteria occurs whenever there is trauma related to the procedure:


Rate of bacteraemia

Bacteraemia occurs at an estimated 12-22% after oesophageal dilatation. Higher if malignant.

14.6% after sclerotherapy

8.8% after EVL

4.4% after OGDS with or without biopsy

0 - 25% after colonoscopy

1% after sigmoidoscopy

4.0- 5.8% after EUS FNA


BUT also in daily activities

20 - 68% after brushing and flossing teeth

20 – 40% after toothpicks

7 – 51% after chewing food


Therefore, the risks of IE due to bacteraemia in endoscopy has been OVERBLOWN

So in the latest AHA ASGE guidelines, antibiobitic prophylaxis SOLELY to prevent IE is now no longer recommended. Except in:


However, antibiotic prophylaxis is still used to prevent infections other than IE:

1.     ERCP (1 -3% cases result in cholangitis)(Antibiotics is given for 5 days if)
2.     EUS FNA of cystic lesion
3.     PEG (given 30 min before procedure)
4.     Cirrhosis with GI Bleeding


Antibiotic prophylaxis is NOT given in these conditions:

  1. Any endoscopy without high risk IE as stated above
  2. ERCP with complete drainage
  3. EUS FNA of solid lesion in upper GI
  4. Synthetic vascular grafts
  5. Non valvular CV devices
  6. Prosthetic joints


 No recommendation:

edited 16th July 2010