Clinical Practice
Guidelines
Antibiotic Prophylaxis in Gastrointestinal Endoscopy
All endoscopists will be aware of the current controversy and differing guidelines on endocarditis prophylaxis for GI procedures. A working group of the BSG Endoscopy Committee met in March 2006 to revise the 2001 guidance.
NICE has now considered this issue as well. It has come out against the use of antibiotic prophylaxis to prevent endocarditis during gastrointestinal endoscopy. Its guidance on endocarditis prophylaxis was unveiled on 26 March 2008:
The BSG guidance is to be updated yet again in the light of the NICE guidance, and then resubmitted to Gut for further peer review. The recommendation is likely to be that routine antibiotic prophylaxis is indicated in the following circumstances only:
- Percutaneous endoscopic gastrostomy (and equivalent procedures)
- ERCP (if pancreatic pseudocyst, or if unliklely/unable to achieve complete biliary decompression)
- Endoscopic ultrasound-guided drainage of pancreatic pseudocyst
Dr Miles Allison