Risks and Outcomes of Peritonitis after Flexible Colonoscopy in CAPD Patients

Abstract

Objective The ISPD 2005 guidelines for peritonitis recommend antibiotic prophylaxis for patients undergoing colonoscopy with polypectomy while on continuous ambulatory peritoneal dialysis (CAPD) but there is little literature to support this recommendation. This study aimed to look into the risks and outcomes of peritonitis after colonoscopy in CAPD patients. Patients and Methods All records of flexible colonoscopy performed on our CAPD patients from January 1994 to January 2006 were retrieved. Demographic and clinical data, use of antibiotics before colonoscopy, endoscopic findings, procedure performed, and peritonitis data were analyzed. Results 77 CAPD patients underwent 97 colonoscopies. No peritonitis developed in the 18 cases where antibiotics were given before colonoscopy. Among those without antibiotic prophylaxis, 4 episodes of peritonitis occurred within 24 hours after the procedure and 1 occurred 5 days later. All responded to intraperitoneal antibiotics. Colonic biopsy and polypectomy were not associated with more peritonitis (2 in 41 with biopsy vs 3 in 38 without biopsy, p = 0.67; 1 in 30 with polypectomy vs 4 in 49 without polypectomy, p = 0.64). Conclusion The risk of peritonitis after colonoscopy without antibiotic prophylaxis was 6.3%. All peritonitis episodes responded to intraperitoneal antibiotics. Colonic biopsy or polypectomy did not appear to increase the risk of peritonitis. Although statistically not significant when compared with patients without antibiotic prophylaxis, we observed no peritonitis after colonoscopy in patients that were given antibiotics for prophylactic purposes or for other reasons. The efficacy of prophylactic antibiotics would be better defined by large randomized trials.

Risk Factors and Outcome of Contamination in Patients on Peritoneal Dialysis—A Single-Center Experience of 15 Years

“…Because ofloxacin is a racemic mixture consisting of 50% levofloxacin and 50% dextro-ofloxacin (which is biologically inactive), the dose of levofloxacin used in the present study (half the dose of oral ofloxacin used in previous studies) was expected to suffice. We use a similar dose of oral levofloxacin for peritonitis prophylaxis during colonoscopy, with good results (8). Our data support the effectiveness and convenience of this antibiotic regimen for prophylaxis.…”

Evaluating the Risk of Peritonitis Post Colonoscopy in End Stage Renal Disease Patients on Peritoneal Dialysis: A Prospective Randomized Trial of Intraperitoneal Prophylactic Antibiotic at a Single Center

“…The authors however, indicated that it lacks statistical significance compared with prior antibiotic prophylaxis [33]. Colon biopsy or polypectomy did not appear to further increase the risk of peritonitis in our cohort [34]. Interestingly, the International Society for Peritoneal Dialysis recommended antibiotic prophylaxis before any procedure involving the abdomen or pelvis, including colonoscopy [14].…”

Preventing peritonitis in PD patients

“…Bowel hygiene with attention to prevention of constipation is also a good approach. Procedures such as colonoscopy can lead to peritonitis, and therefore the abdomen should be empty of dialysis fluid during these procedures 9. I recommend prophylactic antibiotics prior to the procedure to prevent this complication.…”

“…I recommend prophylactic antibiotics prior to the procedure to prevent this complication. Such an approach decreases the risk of peritonitis from about 5% to close to 0% 9…”