S200 Prophylactic Antibiotics and Post-Procedural Infectious Complications in Endoscopic Retrograde Cholangiopancreatography With Peroral Cholangioscopy: A Systematic Review and Meta-Analysis

Introduction: Single-operator peroral cholangioscopy (SOC) has been associated with higher rates of infectious complications compared to conventional endoscopic retrograde cholangiopancreatography. Several guidelines therefore recommend antibiotic prophylaxis (AP), but the real-world impact of AP administration on infectious adverse events has been poorly studied. We conducted a systematic review and meta-analysis of studies assessing the impact of AP use on infectious complications of SOC. Methods: A systematic review of the literature from MEDLINE, EMBASE and Scopus was conducted from inception to April 2025, for studies comparing the risk of infectious complications of SOC with and without AP. Outcomes of interest were the incidence of cholangitis and other infections following SOC. Standard meta-analysis methods were followed using the random-effects model. Treatment effect estimates were expressed as odds ratio (OR) and 95% confidence interval (CI). Heterogeneity was assessed using the I2% statistic. Results: Four retrospective studies were included that reported on 5036 patients. Three studies were multicenter while 1 was single center. All the studies were from different countries. AP was used in 3911 patients, while 1,169 patients did not receive AP. The most reported indication was biliary stones (n = 598). There was a trend towards decreased odds of post-SOC cholangitis in the AP group compared to the non-AP group. However, it was not statistically significant (OR 0.58; 95% CI [0.27, 1.26], P = 0.17). The odds of post-SOC infections had a slightly negative trend in the AP group but without statistical significance (OR 0.85; 95% CI [0.60, 1.20], P = 0.36). Conclusion: This meta-analysis suggests a potential benefit of AP in reducing the risk of cholangitis and other infections following SOC, although statistical significance was not achieved. The lack of significance may be due to the small number of available studies and inherent study limitations. Larger, prospective studies are warranted to better define the role of prophylaxis in minimizing infectious complications after SOC.