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Prophylactic antibiotics after peroral endoscopic myotomy may not significantly reduce postprocedural fever or
Qiang Yang1, Foqiang Liao1,2, Tingting Jiang1
1Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China.
Background:
Peroral endoscopic myotomy (POEM) has become a standard treatment for achalasia. Routine prophylactic antibiotics are still widely used after POEM, although clinical evidence supporting this common practice remains limited. This study aims to evaluate the clinical necessity of routine postoperative prophylactic antibiotics in patients with achalasia undergoing POEM.
Methods:
We conducted a retrospective analysis of 340 achalasia patients who underwent POEM at the First Affiliated Hospital of Nanchang University between January 2012 and December 2024. Based on postoperative prophylactic antibiotic use, patients were divided into two groups: the prophylactic antibiotic (PA) group and the non-prophylactic antibiotic (non-PA) group. To minimize selection bias, 1:1 propensity score matching (PSM) was performed with a caliper of 0.1.
Results:
In the overall cohort, patients were divided into PA group (n = 279, 82.1%) and non-PA group (n = 61, 17.9%). After matching, the baseline characteristics of the 56 patients in the PA group were well-balanced with those of the 56 patients in the non-PA group (all p > 0.05). There were no significant differences between the two groups in the incidence of postprocedural fever, infection or the median length of hospital stay (p > 0.05). In the full-thickness myotomy subgroup, there were no significant differences between the two groups in the incidence of postprocedural fever and infection. However, the incidence of cough was significantly higher in the non-PA group compared to the PA group (p = 0.040).
Conclusion:
Routine prophylactic antibiotics after POEM for patients with achalasia may not significantly reduce postprocedural fever, infection, or length of hospital stay.
Insights
Routine prophylactic antibiotics after peroral endoscopic myotomy (POEM) for achalasia do not significantly reduce fever, infection, or hospital stay. This challenges the common practice of using antibiotics post-POEM, suggesting a need to re-evaluate their necessity.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Infectious Disease Prevention
Background:
- Peroral endoscopic myotomy (POEM) is a standard treatment for achalasia.
- Prophylactic antibiotic use post-POEM is common but lacks strong clinical evidence.
- This study investigates the necessity of routine antibiotics after POEM.
Purpose of the Study:
- To evaluate the clinical necessity of routine prophylactic antibiotics in achalasia patients undergoing POEM.
- To determine if antibiotics impact postprocedural fever, infection rates, or hospital stay.
Main Methods:
- Retrospective analysis of 340 achalasia patients undergoing POEM.
- Comparison between prophylactic antibiotic (PA) and non-prophylactic antibiotic (non-PA) groups.
- 1:1 propensity score matching (PSM) to minimize bias.
Main Results:
- No significant differences in postprocedural fever, infection, or hospital stay between PA and non-PA groups after PSM (n=56 each).
- In the full-thickness myotomy subgroup, fever and infection rates were similar.
- A higher incidence of cough was observed in the non-PA group (p=0.040).
Conclusions:
- Routine prophylactic antibiotics after POEM for achalasia may not be clinically necessary.
- Antibiotics did not significantly reduce fever, infection, or length of hospital stay.
- Further evaluation of antibiotic necessity in POEM procedures is warranted.
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