Antibiotic Prophylaxis for Peroral Cholangioscopy: A Systematic Review and Meta-analysis.

Authors

Tareq Alsaleh, Baha Fawwaz, Mohamad Khaled Almujarkesh, Hamza Akram, Calvin Jose, Nouman Shafique, Amna S Malik, Mustafa Arain, John George

Published in

Gastrointestinal endoscopy. Aug 20, 2026. Epub Aug 20, 2026.

Abstract

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.
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.
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.
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.

PMID:
42624299
Bibliographic data and abstract were imported from PubMed on 21 Aug 2026.

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