{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T14:19:31Z","timestamp":1766067571209,"version":"3.41.2"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,5]],"date-time":"2022-07-05T00:00:00Z","timestamp":1656979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Although endoscopic treatment of symptomatic post-inflammatory pancreatic and peripancreatic fluid collections (PPPFCs) is an established treatment method, some aspects of endotherapy and periprocedural management remain controversial. The role of antibiotics is one of the most controversial issues in interventional endoscopic management of local complications of pancreatitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study was a randomized, non-inferiority, placebo-controlled, and double-blinded clinical trial to investigate the role of antibiotic prophylaxis in endoscopic transmural drainage in patients with symptomatic non-infected PPPFCs and assess the influence of antibiotic treatment on the results of endotherapy in patients with symptomatic infected PPPFCs.<\/jats:p><jats:p>This trial included 62 patients treated endoscopically for PPPFCs in 2020 at our medical center. Patients were divided into two groups; group 1 comprised patients who had received empirical intravenous antibiotic therapy during endotherapy and group 2 comprised patients who did not receive antibiotic therapy during endoscopic drainage of PPPFCs. The end points were clinical success and long-term success of endoscopic treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty-one patients were included in group 1 (walled-off pancreatic necrosis [WOPN, 51.6%; pseudocyst, 48.4%) and 31 patients in group 2 (WOPN, 58.1%; pseudocyst, 41.9%) (p=0.6098\/nonsignificant statistical [NS]). Infection with PPPFCs was observed in 15\/31 (48.39%) patients in group 1 and in 15\/31 (48.39%) patients in group 2 (p=1.0\/NS). The average time of active (with flushing through nasocystic drainage) drainage in group 1 was 13.0 (6 \u2013 21) days and was 14.0 (7 \u2013 25) days in group 2 (p=0.405\/NS). The average total number endoscopic procedures on one patient was 3.3 (2 \u2013 5) in group 1 and 3.4 (2 \u2013 7) in group 2 (p=0.899\/NS). Clinical success of PPPFCs was observed in 29\/31 (93.5%) patients from group 1 and in 30\/31 (96.8%) patients from group 2 (p=0.5540\/NS). Complications of endotherapy were noted in 8\/31 (25.8%) patients in group 1 and in 10\/31 (32.3%) patients in group 2 (p=0.576\/NS). Long-term success in group 1 and 2 was reported in 26\/31 (83.9%) and 24\/31 (77.4%) patients, respectively (p=0.520\/NS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The effective endoscopic drainage of sterile PPPFCs requires no preventive or prophylactic use of antibiotics. In infected PPPFCs, antibiotic therapy is not required for effective endoscopic transmural drainage.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2022.939138","type":"journal-article","created":{"date-parts":[[2022,7,5]],"date-time":"2022-07-05T04:32:42Z","timestamp":1656995562000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["The Role of Antibiotics in Endoscopic Transmural Drainage of Post-Inflammatory Pancreatic and Peripancreatic Fluid Collections"],"prefix":"10.3389","volume":"12","author":[{"given":"Mateusz","family":"Jagielski","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wojciech","family":"Kupczyk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacek","family":"Pi\u0105tkowski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marek","family":"Jackowski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,7,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1055\/a-0588-5365","article-title":"Endoscopic Management of Acute Necrotizing Pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Evidence-Based Multidisciplinary Guidelines","volume":"50","author":"Arvanitakis","year":"2018","journal-title":"Endoscopy"},{"key":"B2","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.gie.2014.08.008","article-title":"Antibiotic Prophylaxis for GI Endoscopy","volume":"81","author":"Khashab","year":"2015","journal-title":"Gastrointest Endosc"},{"key":"B3","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of Acute Pancreatitis\u20132012: Revision of the Atlanta Classification and Definitions by International Consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1016\/j.ajem.2018.01.073","article-title":"The Quick Sequential Organ Failure Assessment (qSOFA) Identifies Septic Patients in the Out-of-Hospital Setting","volume":"36","author":"Barbara","year":"2018","journal-title":"Am. J. Emerg. Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1007\/s11894-009-0021-7","article-title":"Minimizing Complications in Pancreaticobiliary Endoscopy","volume":"11","author":"Barkay","year":"2009","journal-title":"Curr. Gastroenterol. Rep."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1642","DOI":"10.1053\/j.gastro.2020.01.025","article-title":"Antibiotic Prophylaxis Is Not Required for Endoscopic Ultrasonography-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions, Based on a Randomized Trial","volume":"158","author":"Col\u00e1n-Hern\u00e1ndez","year":"2020","journal-title":"Gastroenterology"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.1053\/j.gastro.2018.01.032","article-title":"American Gastroenterological Association Institute Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis","volume":"154","author":"Crockett","year":"2018","journal-title":"Gastroenterology"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e65","DOI":"10.1002\/bjs.9346","article-title":"Staged Multidisciplinary Step-Up Management for Necrotizing Pancreatitis","volume":"101","author":"da Costa","year":"2014","journal-title":"Br. J. Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"2308","DOI":"10.1007\/s10620-019-05655-x","article-title":"Antibiotics Do Not Decrease the Rate of Infection After Endoscopic Ultrasound Fine-Needle Aspiration of Pancreatic Cysts","volume":"64","author":"Facciorusso","year":"2019","journal-title":"Dig. Dis. Sci."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1176","DOI":"10.1097\/MPA.0b013e318269c660","article-title":"Interventions for Necrotizing Pancreatitis: Summary of a Multidisciplinary Consensus Conference","volume":"41","author":"Freeman","year":"2012","journal-title":"Pancreas"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10040761","article-title":"The Role of Endoscopic Transpapillary Stenting of the Main Pancreatic Duct During the Endoscopic Treatment of Pancreatic Fluid Collections","volume":"10","author":"Jagielski","year":"2021","journal-title":"J. Clin. Med."},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/4351151","article-title":"The Role of Lumen-Apposing Metal Stents in Transmural Endoscopic Drainage of Postinflammatory Pancreatic and Peripancreatic Fluid Collections","volume":"2021","author":"Jagielski","year":"2021","journal-title":"Gastroenterol. Res. Pract."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/8149410","article-title":"The Development of Endoscopic Techniques for Treatment of Walled-Off Pancreatic Necrosis: A Single-Center Experience","volume":"2018","author":"Jagielski","year":"2018","journal-title":"Gastroenterol. Res. Pract."},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9010117","article-title":"Various Endoscopic Techniques for Treatment of Consequences of Acute Necrotizing Pancreatitis: Practical Updates for the Endoscopist","volume":"9","author":"Jagielski","year":"2020","journal-title":"J. Clin. Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2383","DOI":"10.1007\/s00268-008-9701-y","article-title":"Minimally Invasive Management of Pancreatic Abscess, Pseudocyst, and Necrosis: A Systematic Review of Current Guidelines","volume":"32","author":"Loveday","year":"2008","journal-title":"World. J. Surg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1097\/SLA.0000000000002065","article-title":"Outcome of Acute Pancreatic and Peripancreatic Collections Occurring in Patients With Acute Pancreatitis","volume":"267","author":"Manrai","year":"2018","journal-title":"Ann. Surg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1001\/archsurg.1989.01410030106018","article-title":"Nosocomial Abscess. Results of an Eight-Year Prospective Study of 32,284 Operations","volume":"124","author":"Olson","year":"1989","journal-title":"Arch. Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.ijid.2020.07.046","article-title":"Management of Intra-Abdominal-Infections: 2017 World Society of Emergency Surgery Guidelines Summary Focused on Remote Areas and Low-Income Nations","volume":"99","author":"Perrone","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1055\/s-0043-119219","article-title":"Technical Aspects of Endoscopic Ultrasound (EUS)-Guided Sampling in Gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017","volume":"49","author":"Polkowski","year":"2017","journal-title":"Endoscopy"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1548","DOI":"10.1111\/jgh.14111","article-title":"Duration of Antibiotic Treatment After Endoscopic Ultrasound-Guided Drainage of Walled-Off Pancreatic Necrosis Not Affecting Outcomes","volume":"33","author":"Sahar","year":"2018","journal-title":"J. Gastroenterol. Hepatol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1721","DOI":"10.1002\/bjs.9666","article-title":"Natural Resolution or Intervention for Fluid Collections in Acute Severe Pancreatitis","volume":"101","author":"Sarathi Patra","year":"2014","journal-title":"Br. J. Surg."},{"key":"B22","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1016\/j.suc.2013.02.012","article-title":"The New Revised Classification of Acute Pancreatitis 2012","volume":"93","author":"Sarr","year":"2013","journal-title":"Surg. Clin. North. Am."},{"key":"B23","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s13017-017-0141-6","article-title":"The Management of Intra-Abdominal Infections From a Global Perspective: 2017 WSES Guidelines for Management of Intra-Abdominal Infections","volume":"12","author":"Sartelli","year":"2017","journal-title":"World. J. Emerg. Surg."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1707","DOI":"10.3748\/wjg.v16.i14.1707","article-title":"Walled-Off Pancreatic Necrosis","volume":"16","author":"Stamatakos","year":"2010","journal-title":"World. J. Gastroenterol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"170","DOI":"10.5114\/wiitm.2014.41628","article-title":"Minimally Invasive Procedures in Severe Acute Pancreatitis Treatment - Assessment of Benefits and Possibilities of Use","volume":"9","author":"Szeliga","year":"2014","journal-title":"Wideochir. Inne. Tech. Maloinwazyjne"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1038\/ajg.2013.218","article-title":"American College of Gastroenterology. American College of Gastroenterology Guideline: Management of Acute Pancreatitis","volume":"108","author":"Tenner","year":"2013","journal-title":"Am. J. Gastroenterol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1148\/radiol.11110947","article-title":"The Revised Atlanta Classification of Acute Pancreatitis: Its Importance for the Radiologist and its Effect on Treatment","volume":"262","author":"Thoeni","year":"2012","journal-title":"Radiology"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.MR000030","article-title":"Consolidated Standards of Reporting Trials (CONSORT) and the Completeness of Reporting of Randomised Controlled Trials (RCTs) Published in Medical Journals","volume":"11","author":"Turner","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002941","article-title":"Antibiotic Therapy for Prophylaxis Against Infection of Pancreatic Necrosis in Acute Pancreatitis","volume":"2010","author":"Villatoro","year":"2010","journal-title":"Cochrane Database Syst. Rev."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1097\/00003246-199811000-00016","article-title":"Use of the SOFA Score to Assess the Incidence of Organ Dysfunction\/Failure in Intensive Care Units: Results of a Multicenter, Prospective Study. Working Group on \u201cSepsis-Related Problems\u201d of the European Society of Intensive Care Medicine","volume":"26","author":"Vincent","year":"1998","journal-title":"Crit. Care Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (Sepsis-Related Organ Failure Assessment) Score to Describe Organ Dysfunction\/Failure. On Behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine","volume":"22","author":"Vincent","year":"1996","journal-title":"Intensive Care Med."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.pan.2013.07.063","article-title":"IAP\/APA Evidence-Based Guidelines for the Management of Acute Pancreatitis","volume":"13","year":"2013","journal-title":"Pancreatology"}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2022.939138\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,5]],"date-time":"2022-07-05T04:32:44Z","timestamp":1656995564000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2022.939138\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,5]]},"references-count":32,"alternative-id":["10.3389\/fcimb.2022.939138"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2022.939138","relation":{},"ISSN":["2235-2988"],"issn-type":[{"type":"electronic","value":"2235-2988"}],"subject":[],"published":{"date-parts":[[2022,7,5]]},"article-number":"939138"}}