← Issue №8/ week of Aug 23, 2026/Endoscopy

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

From GI Signals issue №8: what this paper found, what it changes, and where it sits against the current standard of care, reviewed by Simon Mathews, MD.

Endoscopy meta analysis · n=2,531 · Aug 20, 2026 · GIE · IF 8.0

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

New evidencemeta-analysissystematic reviewERCP
Clinical takeawayThe evidence is too weak to change current practice in either direction. The confidence interval is wide and crosses near-equivalence, sensitivity analyses were unstable, and the authors explicitly call for prospective studies before recommendations shift. Whether you currently use prophylaxis or not, this evidence does not argue for a change. Individualize based on local practice patterns until stronger evidence emerges.
What it foundAntibiotic prophylaxis reduced post-cholangioscopy cholangitis from 7.8% to 3.0% (risk ratio 0.46, 95% CI 0.22-0.95) in a meta-analysis of six studies with 2,531 patients, but the estimate was borderline significant and not robust to individual study removal; certainty of evidence was very low.
ContextAntibiotic prophylaxis before ERCP with cholangioscopy is common practice but has long lacked strong supporting evidence. This meta-analysis sought to quantify benefit but found borderline, very low certainty evidence, leaving the evidence base essentially unchanged: current practice remains unjustified by published trial data.
Emergingsuggested applicable standard· American College of Gastroenterology, 'Diagnosis and Management of Choledocholithiasis', 2019

Decision at stakeWhether to give antibiotic prophylaxis before peroral cholangioscopy to prevent post-procedure cholangitis

No single passage of this standard matched the paper closely enough to quote, so none is shown. The standard is cited above.

Our full summary of this standard

For right upper quadrant pain, characterize the pattern (acute vs chronic, post-meal vs unrelated, with vs without fever/jaundice) and triage acute red-flag presentations (Murphy sign, Charcot's triad, painless jaundice with weight loss, pregnancy with LFT/coagulation derangement) to the ED. Obtain labs (CBC, CMP with LFTs, lipase, urinalysis, pregnancy test in reproductive-age women) and RUQ ultrasound as first imaging, then direct further workup by ultrasound findings, cholecystectomy for acute cholecystitis, MRCP for suspected choledocholithiasis based on risk stratification (e.g., high-risk criteria including CBD dilation >6 mm, bilirubin >4 mg/dL, or gallstone pancreatitis), CCK-HIDA/GBEF for acalculous functional gallbladder disorder, and cross-sectional imaging for liver masses or other pathology.

American College of Gastroenterology, 'Diagnosis and Management of Choledocholithiasis', 2019 · reviewed 2026-07-21 ↗
Alsaleh T … George J · Gastrointestinal Endoscopy · IF 8.0 · PubMed ↗Permalink
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