Safety of Endoscopy in Peritoneal Dialysis Patients

Abstract

INTRODUCTION: Endoscopic procedures can provoke peritonitis in patients receiving peritoneal dialysis (PD). The aim of this study was to assess the development of peritonitis after endoscopic procedures in PD patients. METHODS: We retrospectively reviewed the data from PD patients who underwent endoscopies in 3 tertiary hospitals between 2008 and 2018. The patients were grouped into nonprophylactic, prophylactic, and prior antibiotic therapy groups. The incidence of peritonitis within 7 days of endoscopy was assessed. We also examined the factors associated with peritonitis. RESULTS: There were 1,316 endoscopies performed in 570 PD patients. The peritonitis rate after endoscopy was 3.0%. Specifically, the peritonitis rate was 1.8% for esophagogastroduodenoscopies, 4.2% for the colonoscopy group, and 5.3% for the sigmoidoscopy group. The prior antibiotic therapy group showed a significantly higher risk of peritonitis (odds ratio = 4.6; 95% confidence interval: 2.2–9.6; P < 0.01). Prophylactic antibiotics were not associated with reducing peritonitis. Therapeutic colonoscopies such as polypectomy were associated with an increased risk of developing peritonitis (odds ratio = 6.5; 95% confidence interval: 1.6–25.9). However, biopsies were not associated with an increased risk of peritonitis. DISCUSSION: Prophylactic antibiotics did not reduce the risk of peritonitis after endoscopy in PD patients. Therapeutic colonoscopies such as polypectomy and prior antibiotic therapy before endoscopy were associated with an increased risk of peritonitis.

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

“…57 More than half of reported peritonitis episodes occurring after colonoscopy are caused by E. coli. 55,60 In a single-centre study of 97 colonoscopies performed in 77 continuous ambulatory peritoneal dialysis (CAPD) patients, none of the 18 patients having a colonoscopy procedure with antibiotic prophylaxis developed peritonitis, as opposed to a 6.3% peritonitis occurrence among those undergoing colonoscopy without antibiotic prophylaxis. 50 This is consistent with a more extensive multicentre study of 236 colonoscopy procedures, in which none of the 65 patients who received antibiotic prophylaxis developed peritonitis, compared to a peritonitis rate of 3.8% for those without prophylactic antibiotics.…”

“…55 Furthermore, therapeutic procedures, such as polypectomy and endoscopic mucosal resection, are predictive of peritonitis. 55,60 The optimal antibiotic regimen for preventing peritonitis after colonoscopy has not been determined by clinical study. The only randomised controlled trial of prophylactic antibiotics used IP ceftazidime (1 g IP 1 h before the procedure) and recruited 93 patients receiving APD without a history of peritonitis in the last 12 months from a single centre in Saudi Arabia.…”

Care of the hospitalised patient receiving peritoneal dialysis: Your questions answered

“…However, antibiotics pre procedure was associated with a lower incidence of PD-peritonitis. 12 We conclude that PD patients may benefit from prophylactic antibiotics prior to upper endoscopy similar to colonoscopy as illustrated in Table 1, especially high-risk patients such as older patients and those who may need tissue biopsy.…”

Clinical characteristics and outcomes of peritoneal dialysis (PD)-related peritonitis after colonoscopy

“…Peritonitis that was developed within 1 week after colonoscopy was defined as colonoscopy-related peritonitis. 3,5,7…”