Endoscopic submucosal dissection-associated bacteremia: proper antibiotic management

Endoscopic submucosal dissection (ESD) is of great value in the medical field as an effective means for the treatment of early gastrointestinal cancer and precancerous lesions. However, due to its technical difficulty and long procedure time, ESD is prone to complications such as perforation, bleeding, and infection. In particular, perforation facilitates the entry of pathogenic microorganisms into the blood circulation through iatrogenic wounds, increasing the risk of bacteremia, which may lead to serious adverse events such as peritonitis and septic shock. Current evidence indicates that the overall incidence of bacteremia after ESD is low (typically <5%), mostly transient, and rarely progresses to clinical infection. This narrative review, based on a systematic search of PubMed, Embase, and the Cochrane Library through January 2026, analyzes the risk of bacteremia in ESD across different parts of the digestive tract and the necessity of antibiotic therapy, aiming to provide a reference for more in-depth exploration and clinical application.