From the Guidelines
An EGD with biopsy does not require antibiotics for most patients, as the risk of infection from this procedure is very low. The decision to administer antibiotics should be based on individual risk assessment, considering the patient's specific risk factors for endocarditis, such as prosthetic heart valves, previous endocarditis, certain congenital heart diseases, or cardiac transplant recipients with valve abnormalities 1. According to the 2020 ACC/AHA guideline for the management of patients with valvular heart disease, patients at high risk for endocarditis should receive antibiotic prophylaxis, typically with amoxicillin 2g orally one hour before the procedure, or for penicillin-allergic patients, clindamycin 600mg orally 1. Some key points to consider when deciding on antibiotic prophylaxis include:
- The risk of developing infective endocarditis (IE) is highest in patients with a prosthetic valve, prior IE, or congenital heart disease with residual flow disturbances 1
- The incidence of IE after most procedures is low, with no controlled data supporting the benefit of antibiotic prophylaxis 1
- Indiscriminate use of antibiotics can be associated with the development of resistant organisms, Clostridium difficile colitis, unnecessary expense, and drug toxicity 1
- The rate of transient bacteremia during or immediately after endoscopy is 2% to 5%, and the organisms typically identified are unlikely to cause IE 1. It is essential to weigh the patient's specific risk factors against the potential downsides of unnecessary antibiotic use, including adverse reactions and contribution to antibiotic resistance 1.
From the Research
EGD with Biopsy and Antibiotics
- There is no direct evidence in the provided studies that suggests an EGD with biopsy requires antibiotics 2, 3, 4, 5, 6.
- The studies focus on different topics such as infective endocarditis, esophagogastroduodenoscopy-associated gastrointestinal perforations, endocarditis and invasive dental procedures, upper gastrointestinal and ulcer bleeding, and esophagogastroduodenoscopy quality improvement.
- None of the studies explicitly address the use of antibiotics in conjunction with an EGD with biopsy.
- However, study 4 discusses the use of antibiotic prophylaxis to prevent endocarditis in high-risk patients undergoing invasive dental procedures, which may be relevant to patients with certain medical conditions undergoing an EGD with biopsy.
Relevant Considerations
- Study 3 highlights the risks associated with esophagogastroduodenoscopy, including perforation, but does not mention the use of antibiotics in this context.
- Study 5 provides guidelines for the management of upper gastrointestinal bleeding, including the use of endoscopy and other treatments, but does not address the use of antibiotics specifically for an EGD with biopsy.
- Study 6 focuses on the use of topical antiperistaltic agents to improve the quality of esophagogastroduodenoscopy, but does not discuss antibiotics.