내시경역행담췌관조영술 후 감염 = Post-Endoscopic Retrograde Cholangiopancreatography Infection

다국어 초록 (Multilingual Abstract)

Infection is a known complication of endoscopic retrograde cholangiopancreatography (ERCP), occurring in up to 1.5% of cases. However, it is important to realize that true incidence may be underestimated because infection may go unnoticed. Post-ERCP infections are considered to be endogenous infections arising from the intestinal bacteria of the patient and introduction of exogenous bacteria through inadequately reprocessed duodenoscopes. During the past years, carbapenem resistance has become a major concern for public health. The infection outbreaks after ERCP are linked to breaches in adherence to disinfection manual and complex design of duodenoscopes difficult to reprocess. The most important risk factor for ERCP-related cholangitis is inadequate biliary drainage. To minimize the risk of post-ERCP infection it would be helpful that the volume of contrast injected into the biliary tree has to be minimized to obtain adequate cholangiogram. In patients with bile duct obstruction and failed drainage of infected bile via ERCP, every effort should be made to achieve prompt decompression of an obstructed biliary system. Antibiotic prophylaxis is recommended only in patients with biliary obstruction in which there is a possibility that complete drainage may not be achieved at the ERCP.

참고문헌 (Reference)

1 최정식, "내시경역행담췌관조영술에서 조영제 주입 전 담즙 흡인의 임상적 효과" 대한소화기학회 60 (60): 368-372, 2012

2 Verfaillie CJ, "Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing Pseudomonas aeruginosa" 47 : 493-502, 2015

3 Kager LM, "The role of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography;a retrospective single-center evaluation" 47 : 245-250, 2012

4 Norouzi A, "The effect of adding gentamicin to contrast media for prevention of cholangitis after biliary stenting for non-calculous biliary obstruction, a randomized controlled trial" 32 : 18-21, 2013

5 Classen DC, "Serious Pseudomonas infections associated with endoscopic retrograde cholangiopancreatography" 84 (84): 590-596, 1988

6 Williams EJ, "Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study" 39 : 793-801, 2007

7 곽민선, "Risk Factors of Post Endoscopic Retrograde Cholangiopancreatography Bacteremia" 거트앤리버 발행위원회 7 (7): 228-233, 2013

8 Subhani JM, "Review article: antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP)" 13 : 103-116, 1999

9 Colton JB, "Quality indicators, including complications, of ERCP in a community setting: a prospective study" 70 : 457-467, 2009

10 Bass DH, "Pseudomonas septicaemia after endoscopic retrograde cholangiopancreatography--an unresolved problem" 77 : 509-511, 1990

11 Struelens MJ, "Pseudomonas aeruginosa and Enterobacteriaceae bacteremia after biliary endoscopy: an outbreak investigation using DNA macrorestriction analysis" 95 : 489-498, 1993

12 Llach J, "Prospective assessment of the role of antibiotic prophylaxis in ERCP" 53 : 540-542, 2006

13 Bai Y, "Prophylactic antibiotics cannot prevent endoscopic retrograde cholangiopancreatography-induced cholangitis: a meta-analysis" 38 : 126-130, 2009

14 Niederau C, "Prophylactic antibiotic treatment in therapeutic or complicated diagnostic ERCP: results of a randomized controlled clinical study" 40 : 533-537, 1994

15 Wilson W, "Prevention of infective endocarditis:guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group" 116 : 1736-1754, 2007

16 Bianco JA, "Prevalence of clinically relevant bacteremia after upper gastrointestinal endoscopy in bone marrow transplant recipients" 89 : 134-136, 1990

17 Räty S, "Post-ERCP pancreatitis: reduction by routine antibiotics" 5 : 339-345, 2001

18 Van den Hazel SJ, "Piperacillin to prevent cholangitis after endoscopic retrograde cholangiopancreatography. A randomized, controlled trial" 125 : 442-447, 1996

19 Earnshaw JJ, "Outbreak of Pseudomonas aeruginosa following endoscopic retrograde cholangiopancreatography" 6 : 95-97, 1985

20 Almadi MA, "No benefit of covered vs uncovered self-expandable metal stents in patients with malignant distal biliary obstruction: a meta-analysis" 11 : 27.e1-37.e1, 2013

21 Epstein L, "New Delhi metallo-β-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes" 312 : 1447-1455, 2014

22 Aumeran C, "Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography" 42 : 895-899, 2010

23 Harris A, "Metaanalysis of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography (ERCP)" 31 : 718-724, 1999

24 Saleem A, "Meta-analysis of randomized trials comparing the patency of covered and uncovered selfexpandable metal stents for palliation of distal malignant bile duct obstruction" 74 : 321-327, 2011

25 Gastmeier P, "Klebsiella spp. in endoscopy-associated infections: we may only be seeing the tip of the iceberg" 42 : 15-21, 2014

26 Lee JK, "Is it necessary to insert a nasobiliary drainage tube routinely after endoscopic clearance of the common bile duct in patients with choledocholithiasis-induced cholangitis? A prospective, randomized trial" 71 : 105-110, 2010

27 Nelson DB, "Infectious disease complications of GI endoscopy: part I, endogenous infections" 57 : 546-556, 2003

28 Cotton PB, "Infection after ERCP and antibiotic prophylaxis: a sequential quality-improvement approach over 11 years" 67 : 471-475, 2008

29 Andriulli A, "Incidence rates of post-ERCP complications: a systematic survey of prospective studies" 102 : 1781-1788, 2007

30 Cotton PB, "Endoscopic sphincterotomy complications and their management: an attempt at consensus" 37 : 383-393, 1991

31 Saxena P, "Endoscopic management of acute cholecystitis after metal stent placement in patients with malignant biliary obstruction: a case series" 78 : 175-178, 2013

32 Zhang R, "Effect of CO2 cholangiography on post-ERCP cholangitis in patients with unresectable malignant hilar obstruction - a prospective, randomized controlled study" 48 : 758-763, 2013

33 Brandes JW, "ERCP: complications and prophylaxis a controlled study" 13 : 27-30, 1981

34 Freeman ML, "Complications of endoscopic biliary sphincterotomy" 335 : 909-918, 1996

35 Mergener K, "Complications of endoscopic and radiologic investigation of biliary tract disorders" 13 : 173-181, 2011

36 Balderramo D, "Complications after ERCP in liver transplant recipients" 74 : 285-294, 2011

37 Isayama H, "Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction" 4 : 1148-1153, 2006

38 Pisello F, "Cholangitis prevention in endoscopic Klatskin tumor palliation: air cholangiography technique" 394 : 1109-1114, 2009

39 Sand J, "Changes in biliary bacteria after endoscopic cholangiography and sphincterotomy" 58 : 324-328, 1992

40 Sung JY, "Bacterial invasion of the biliary system by way of the portal-venous system" 14 : 313-317, 1991

41 Leung JW, "Antibiotics, biliary sepsis, and bile duct stones" 40 : 716-721, 1994

42 Lorenz R, "Antibiotic prophylaxis using cefuroxime in bile duct endoscopy" 121 : 223-230, 1996

43 Thompson BF, "Antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography in patients with obstructive jaundice: is it worth the cost?" 16 : 727-734, 2002

44 Sauter G, "Antibiotic prophylaxis of infectious complications with endoscopic retrograde cholangiopancreatography. A randomized controlled study" 22 : 164-167, 1990

45 Spicak J, "Antibiotic prophylaxis of cholangitis complicating endoscopic treatment of biliary obstruction" 55 : 211-215, 2001

46 Brand M, "Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography" (10) : CD007345-, 2010

47 Byl B, "Antibiotic prophylaxis for infectious complications after therapeutic endoscopic retrograde cholangiopancreatography:a randomized, double-blind, placebo-controlled study" 20 : 1236-1240, 1995

48 Minami T, "Antibiotic prophylaxis for endoscopic retrograde chlangiopancreatography increases the detection rate of drug-resistant bacteria in bile" 21 : 712-718, 2014

49 ASGE Standards of Practice Committee, "Antibiotic prophylaxis for GI endoscopy" 81 : 81-89, 2015

50 Sud R, "Air cholangiogram is not inferior to dye cholangiogram for malignant hilar biliary obstruction:a randomized study of efficacy and safety" 33 : 537-542, 2014

51 Ramirez FC, "Addition of gentamicin to endoscopic retrograde cholangiopancreatography (ERCP) contrast medium towards reducing the frequency of septic complications of ERCP" 11 : 237-243, 2010