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Antibiotic Prophylaxis for Peroral Cholangioscopy: A Systematic Review and Meta-analysis
Tareq Alsaleh1, Baha Fawwaz2, Mohamad Khaled Almujarkesh2
1Internal Medicine, AdventHealth Orlando, Orlando, FL.
Background And Aims:
Antibiotic prophylaxis is commonly used before ERCP with peroral cholangioscopy, but supporting evidence is limited. We evaluated whether prophylaxis reduces post-procedural cholangitis after cholangioscopy.
Methods:
We searched Embase, PubMed, Web of Science, and Scopus through February 2026 for studies reporting cholangitis stratified by prophylaxis exposure. Random-effects meta-analysis was used to pool risk ratios.
Results:
Six studies including 2,531 patients and 2,575 procedures were included. The pooled cholangitis rate was 3.0% with prophylaxis and 7.8% without prophylaxis. Antibiotic prophylaxis was associated with lower cholangitis risk (risk ratio, 0.46; 95% confidence interval, 0.22-0.95; I2 = 40.4%), although the estimate was of borderline significance and not robust to individual study removal. Certainty of evidence was very low.
Conclusions:
Antibiotic prophylaxis was associated with a reduction in post-cholangioscopy cholangitis that was of borderline significance and sensitive to individual studies. Prospective studies are needed to define optimal patient selection and regimens.
