Background: Post-polypectomy coagulation syndrome (PECS) is a well-known adverse event after endoscopic polypectomy for colorectal lesions. To date, there are no standardized guidelines for the antimicrobial prophylaxis. The aim of this meta-analysis is to evaluate the usefulness of antibiotics in patients undergoing endoscopic mucosal or submucosal resections. Methods: A comprehensive literature search of PubMed, MEDLINE, EMBASE, and Web of Science databases was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies investigating the role of prophylactic antibiotic administration in reducing the PECS after endoscopic polypectomy were considered. The terms used to search were (“antimicrobial”OR”antibiotics”OR”prophylaxis”OR”prophylactic”) AND (“resection”OR”polypectomy”OR”dissection”) AND (“endoscopic”OR”mucosal”OR”submucosal”) AND (“colon”OR”colorectal”OR”colonic”OR”rectum”). Data of included studies were collected and analysed. Results: The literature search revealed 262 articles, 3 of whom were randomized trials and one was a retrospective study. Patients included were 850 (548 treated with antibiotics and 302 received no treatment). The overall incidence rate was 2.4 and 19.9% in treatment and control groups, respectively. The pooled analysis showed a reduction of 83% of postoperative events in the antibiotics group (relative risk 0.181; 95% CI 0.100–0.326, p < 0.001). Conclusions: In our meta-analysis, the antibiotic prophylaxis showed a positive effect in reducing the incidence of postoperative adverse events other than perforation and bleeding in patients treated with endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions. Despite the low-level of evidence of this meta-analysis, the antibiotic prophylaxis should be taken into account. Further multicenter, large-sample, randomized controlled studies are needed to confirm our results and to evaluate whether specific subgroups of patients could actually benefit from an antibiotic prophylaxis.

Keywords:
Endoscopic mucosal resection, Endoscopic submucosal dissection, Antibiotic prophylaxis, Postoperative complications
1.
Reumkens A, Rondagh EJ, Bakker CM, Winkens B, Masclee AA, Sanduleanu S. Post-Colonoscopy Complications: A Systematic Review, Time Trends, and Meta-Analysis of Population-Based Studies.
Am J Gastroenterol
. 2016 Aug;111(8):1092–101.
2.
Cha JM, Lim KS, Lee SH, Joo YE, Hong SP, Kim TI, et al. Clinical outcomes and risk factors of post-polypectomy coagulation syndrome: a multicenter, retrospective, case-control study.
Endoscopy
. 2013;45(3):202–7.
3.
Hirasawa K, Sato C, Makazu M, Kaneko H, Kobayashi R, Kokawa A, et al. Coagulation syndrome: delayed perforation after colorectal endoscopic treatments.
World J Gastrointest Endosc
. 2015 Sep;7(12):1055–61.
4.
Yamashina T, Takeuchi Y, Uedo N, Hamada K, Aoi K, Yamasaki Y, et al. Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm.
J Gastroenterol Hepatol
. 2016 Mar;31(3):615–20.
5.
Arimoto J, Higurashi T, Kato S, Fuyuki A, Ohkubo H, Nonaka T, et al. Risk factors for post-colorectal endoscopic submucosal dissection (ESD) coagulation syndrome: a multicenter, prospective, observational study.
Endosc Int Open
. 2018 Mar;6(3):E342–9.
6.
Jung D, Youn YH, Jahng J, Kim JH, Park H. Risk of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum.
Endoscopy
. 2013 Sep;45(9):714–7.
7.
Tang X, Gong W, Jiang B. Antibiotic prophylaxis for GI endoscopy.
Gastrointest Endosc
. 2015 Jun;81(6):1503–4.
8.
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
J Clin Epidemiol
. 2009 Oct;62(10):1006–12.
9.
Study Quality Assessment of Controlled Intervention Studies NHLBI. National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools.
10.
Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence.
J Clin Epidemiol
. 2011 Apr;64(4):401–6.
11.
DerSimonian R, Laird N. Meta-analysis in clinical trials.
Control Clin Trials
. 1986 Sep;7(3):177–88.
12.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis.
Stat Med
. 2002 Jun;21(11):1539–58.
13.
Harbord RM, Harris RJ, Sterne JA. Updated tests for small-study effects in meta-analyses.
Stata J
. 2009;9(2):197–210.
14.
Lee SP, Sung IK, Kim JH, Lee SY, Park HS, Shim CS, et al. A randomized controlled trial of prophylactic antibiotics in the prevention of electrocoagulation syndrome after colorectal endoscopic submucosal dissection.
Gastrointest Endosc
. 2017 Aug;86(2):349–357.e2.
15.
Zhang QS, Han B, Xu JH, Gao P, Shen YC. Antimicrobial prophylaxis in patients with colorectal lesions undergoing endoscopic resection.
World J Gastroenterol
. 2015 Apr;21(15):4715–21.
16.
Shi Z, Qiu H, Liu H, Yu H. Should antibiotics be administered after endoscopic mucosalresection in patients with colon polyps?
Turk J Med Sci
. 2016 Nov;46(5):1486–90.
17.
Muro T, Higuchi N, Imamura M, Nakagawa H, Honda M, Nakao K, et al. Post-operative infection of endoscopic submucosal dissection of early colorectal neoplasms: a case-controlled study using a Japanese database.
J Clin Pharm Ther
. 2015 Oct;40(5):573–7.
18.
Min BH, Chang DK, Kim DU, Kim YH, Rhee PL, Kim JJ, et al. Low frequency of bacteremia after an endoscopic resection for large colorectal tumors in spite of extensive submucosal exposure.
Gastrointest Endosc
. 2008 Jul;68(1):105–10.
19.
Wallace MB. New Strategies to Improve Polypectomy During Colonoscopy. Gastroenterol Hepatol (N Y). 2017 Oct;13(10 Suppl 3):1-12.
20.
Waye JD. The postpolypectomy coagulation syndrome.
Gastrointest Endosc
. 1981;27(3):184.
21.
Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem.
Ther Adv Drug Saf
. 2014 Dec;5(6):229–41.
© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.