Abstract
Aim
Cholangitis is the most common infectious complication of ERCP. In vitro studies showed that addition of aminoglycosides to contrast medium was effective in reducing cholangitis but the results of clinical trials are conflicting. We studied the effect of adding gentamicin to contrast medium in reducing the rate of post-ERCP cholangitis in patients with non-calculous obstructive jaundice.
Methods
All patients with non-calculous obstructive jaundice who underwent endoscopic biliary stenting at the Shariati Hospital, Tehran, between December 2009 and October 2010 were enrolled in the study. Gentamicin (10 mg) or distilled water was added to each 10 cc contrast medium during ERCP. Intravenous antibiotics were administered before and after the procedure in all patients. After ERCP and stent deployment, patients were followed for 72 h for symptoms and signs of cholangitis.
Results
A total of 114 patients were eligible for the study. Of these, 57 patients were included in each group. Cholangiocarcinoma was the most prevalent diagnosis. The obstruction was relieved in all patients by stenting. Five patients in each group (8.8 %) developed cholangitis. There was no significant difference in the incidence of cholangitis between the two groups (p = 1.000).
Conclusions
With adequate drainage of the obstructed biliary tract by proper stenting, adding gentamicin to contrast media had no significant effect on incidence of post-ERCP cholangitis.
Similar content being viewed by others
References
Loperfido S, Caroli A. Post-ERCP septic complications. In: UpToDate, Rose, BD, eds. Uptodate, Inc., Waltham, MA; 2009. 17.3
Motte S, Deviere J, Dumonceau JM, Serruys E, Thys JP, Cremer M. Risk factors for septicemia following endoscopic biliary stenting. Gastroenterology. 1991;101:1374–81.
Deviere J, Baize M, de Toeuf J, Cremer M. Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. Gastrointest Endosc. 1988;34:95–101.
Rerknimitr R, Attasaranya S, Kladchareon N, Mahachai V, Kullavanijaya P. Feasibility and complications of endoscopic biliary drainage in patients with malignant biliary obstruction at King Chulalongkorn Memorial Hospital. J Med Assoc Thai. 2002;85 Suppl 1:S48–53.
Rerknimitr R, Fogel EL, Kalayci C, Esber E, Lehman GA, Sherman S. Microbiology of bile in patients with cholangitis or cholestasis with and without plastic biliary endoprosthesis. Gastrointest Endosc. 2002;56:885–9.
Deviere J, Motte S, Dumonceau JM, Serruys E, Thys JP, Cremer M. Septicemia after endoscopic retrograde cholangiopancreatography. Endoscopy. 1990;22:72–5.
Boender J, Nix GA, de Ridder MA, et al. Endoscopic sphincterotomy and biliary drainage in patients with cholangitis due to common bile duct stones. Am J Gastroenterol. 1995;90:233–8.
Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998;48:1–10.
Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–18.
Standards ASGE of Practice Committee, Banerjee S, Shen B, Nelson DB, et al. Infection control during GI endoscopy. Gastrointest Endosc. 2008;67:781–90.
Jendrzejewski JW, McAnally T, Jones SR, Katon RM. Antibiotics and ERCP: in vitro activity of aminoglycosides when added to iodinated contrast agents. Gastroenterology. 1980;78:745–8.
Ramirez FC, Osato MS, Graham DY, Woods KL. Addition of gentamicin to endoscopic retrograde cholangiopancreatography (ERCP) contrast medium towards reducing the frequency of septic complications of ERCP. J Dig Dis. 2010;11:237–43.
Collen MJ, Hanan MR, Maher JA, Stubrin SE. Modification of endoscopic retrograde cholangiopancreatography (ERCP) septic complications by the addition of an antibiotic to the contrast media. Randomized controlled investigation. Am J Gastroenterol. 1980;74:493–6.
Bernadino KP, Howell DA, Lawrence C, et al. Near absence of septic complications following successful therapeutic ERCP justifies selective intravenous and intracontrast use of antibiotics. Gastrointest Endosc. 2005;61:AB187.
Pugliese V, Saccomanno S, Bonelli L, Aste H. Is it useful to add gentamycin to contrast media in endoscopic retrograde cholangiopancreatography? Prospective evaluation of 330 cases. Minerva Dietol Gastroenterol. 1986;32:149–56.
McGuire DE, Brown RD, Venu RP, et al. Intraductal gentamicin during ERCP: Does it prevent cholangitis? Gastrointest Endosc. 1995;41:406.
Author information
Authors and Affiliations
Corresponding author
Additional information
ClinicalTrials.gov Identifier: NCT01148693.
Rights and permissions
About this article
Cite this article
Norouzi, A., Khatibian, M., Afroogh, R. et al. The effect of adding gentamicin to contrast media for prevention of cholangitis after biliary stenting for non-calculous biliary obstruction, a randomized controlled trial. Indian J Gastroenterol 32, 18–21 (2013). https://doi.org/10.1007/s12664-012-0208-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12664-012-0208-y