BSG Guideline: Antibiotic Prophylaxis in Gastrointestinal Endoscopy

First published: January 2012        Last reviewed: April 2022

Bacteraemia is common following some forms of gastrointestinal endoscopic therapy, such as dilatation or injection sclerotherapy, and can occur with diagnostic endoscopy alone. Fortunately complications resulting from dissemination of endogenous bacteria are uncommon, and infective endocarditis is an extremely rare complication. Furthermore, for most diagnostic and therapeutic procedures there is scant evidence that antibiotic prophylaxis can reduce the incidence of infective complications.

The area that has attracted the most controversy in recent years has been the use of antibiotics to prevent infective endocarditis. The recommendations by the American Heart Association (AHA) have traditionally guided the advice of the national bodies representing endoscopic practice, including the British Society of Gastroenterology (BSG). The traditional guidance has been that patients at high risk of endocarditis, such as those with a prosthetic (ie, tissue or mechanical) valve and/or a past history of endocarditis should receive antibiotics for all endoscopic procedures. More recently the European Society of Cardiology recommended antibiotic prophylaxis to cover therapeutic endoscopy in patients with acquired valvular heart disease, and the British Cardiovascular Society went even further, advising antibiotic prophylaxis for patients at moderate risk of endocarditis undergoing any endoscopic procedure.

The Endoscopy Committee of the BSG recognised the need for consensus on this issue, and convened a Working Party in the spring of 2006. The membership, comprised doctors with a special interest in gastroenterology, gastroenterologists, cardiologists and microbiologists. The gastroenterologists and microbiologists from this Working Party also took the opportunity to review the evidence underpinning the use of antibiotic prophylaxis in other areas of endoscopic practice, in particular endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous endoscopic gastrostomy (PEG). In view of new guidance from the AHA, and from the National Institute for Health and Clinical Excellence (NICE), the Working Party reconvened in 2008 to reconsider, in particular, the issue of prophylaxis against infective endocarditis.

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