Post-operative infection of endoscopic submucosal dissection of early colorectal neoplasms: a case-controlled study using a Japanese database

Abstract

Summary What is known and objective Endoscopic submucosal dissection of early colorectal neoplasms (ESD‐ECN) is known to be an operation with risk of contamination, possibly requiring pre‐operative antimicrobial prophylaxis for the prevention of post‐operative infection. However, an evaluation of the need for pre‐operative antimicrobial prophylaxis for ESD‐ECN has yet to be reported. The objective of this study was to determine whether pre‐operative antimicrobial prophylaxis is associated with a reduced incidence of post‐operative infection following ESD‐ECN. Methods The present retrospective case–controlled study utilized a database built from the medical records of 14 university hospitals throughout Japan. Patients who were admitted and discharged from the hospital from April 2012 to October 2013 and who had undergone ESD‐ECN were included in the study. Patients who had been undergone any other operation during their course of hospitalization, and patients who were prescribed antimicrobial agents for reasons other than post‐operative infection or for prophylaxis were excluded. Characteristics of the study population, pre‐operative antimicrobial prophylaxis and antimicrobial therapy for post‐operative infection were investigated. In addition, we compared the characteristics of patients with post‐operative infection (PI) and those with no post‐operative infection (NPI). Univariate analyses were used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI). Results and discussion We obtained the records of 522 patients who had undergone ESD‐ECN from the database. After application of exclusion criteria, 421 patients were enrolled. The post‐operative infection rate was 1·2%. Peritonitis was found most to be the most common post‐operative infection (44%). Pre‐operative antimicrobial prophylaxis was used for 314 patients (75%), with a median duration of 3·0 (range 1–11) days. Cefotiam was most frequently prescribed for pre‐operative antimicrobial prophylaxis (56%). Antimicrobial therapies were started 1–10 days after ESD‐ECN for a duration of 1–14 days. Pre‐operative antimicrobial prophylaxis was not associated with post‐operative infection rate, with an OR (95% CI) of 0·73 (0·08–6·61). However, digestive tract perforation was shown to be associated with post‐operative infection and had an OR (95% CI) of 17·1 (1·66–176·45). What is new and conclusion Post‐operative infection is an exceedingly rare event following ESD‐ECN. Pre‐operative antimicrobial prophylaxis had no significant effect on post‐operative infection following ESD‐ECN and thus may be unnecessary. Instead, prevention of digestive tract perforation may be more critical for the decrease in post‐operative infections.

Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

“…On the other hand, a more recent multicenter RCT including 380 patients showed that perioperative antibiotics did not significantly decrease the incidence of PEECS, at 4.7 % in the antibiotic group versus 7.5 % in the nonantibiotic group ( P = 0.209) 195 . Another large retrospective case–control study from Japan showed that the post-ESD infection rate was low (1.2 %) and that antimicrobial prophylaxis did not prevent postoperative infection (OR 0.73, 95 %CI 0.08–6.61) 196 . In this regard, another study identified cecal location (OR 14.5), presence of submucosal fibrosis (OR 2.8), and female sex (OR 2.6) as independent risk factors for PEECS 197 .…”

Automated machine learning to predict the difficulty for endoscopic resection of gastric gastrointestinal stromal tumor

“…Delayed bleeding was defined as clinical evidence of bleeding that occurred after ER, as evidenced by hematemesis or melena, a decline in hemoglobin levels of more than 2.0 g/dL within 24 hours, or the need for endoscopic therapy ( 22 ). Delayed perforation was verified through X-ray or CT. Postoperative infection was determined by a postoperative body temperature exceeding 37.5°C and/or an increase in inflammatory indicators such as blood routine, CRP, or calcitonin ( 23 ). R0 resection was defined as the surgical removal of a tumor with no residual cancerous tissue detected in the margins of the excised tissue, as confirmed by histological examination of the specimen’s radial and deep margins ( 24 ).…”

Assessment of a Real-world Learning Curve for the Endoscopic Resection of Gastric Gastrointestinal Stromal Tumors

“…A diagnosis of delayed hemorrhage was confirmed by emergency endoscopy, and a diagnosis of delayed perforation was confirmed by X-ray or CT. Postoperative infection was defined as a postoperative body temperature >37.5°C, accompanied by indicators of inflammation on laboratory testing (routine blood data, high C-reactive protein concentration, or high calcitonin concentration. 14 An R0 resection was defined on the basis of histological examination of the lateral and vertical margins, which showed no residual tumor. 15 …”