The Use of Antibiotics in Endoscopic Bariatric Therapies

Introduction: Endoscopic bariatric therapies (EBT) are effective and increasingly popular treatments for obesity as both a primary intervention and following previous bariatric surgery. It is uncertain whether prophylactic antibiotic administration is needed for EBT, as it is in traditional bariatric surgery. We suspect there is significant variation in practice among providers given the limited available data. The aim of this study was therefore to assess antibiotic administration and outcomes for patients undergoing EBT. Methods: Consecutive patients with obesity who underwent EBT for weight loss at a tertiary referral center between July 2018 and June 2021 were evaluated retrospectively. All data pertaining to peri-procedural care, antibiotic administration, and procedure-related complications was obtained. The primary outcome was the rate of antibiotic administration, while the secondary outcomes were to evaluate for adverse events, including need for hospitalization and the presence of infection within 30 days of procedure. Statistical analysis was performed using Fisher’s exact test and Chi-squared test. Results: A total of 84 patients (69 female, mean age 51.4 ± 9.9) who underwent EBT were identified during the study period. Eight patients had primary endoscopic sleeve gastroplasty (ESG), 12 had revision of surgical sleeve gastrectomy (sleeve revision), 33 had transoral outlet reduction (TORe), and 31 patients had transoral outlet reduction with gastroplasty (TORe-G). A total of 18 patients received prophylactic antibiotics, and 7 received antibiotics on discharge. Antibiotic use was highest in ESG and sleeve revision procedures. A total of 13 (15.5%) patients were hospitalized immediately after the procedure for symptom management and 3 (3.6%) patients were readmitted (Table 1). The use of antibiotics during procedures (p = 0.29) or on discharge (p = 0.66) was not predictive of admission or of readmission (p > 0.05). There were no cases of infection regardless of antibiotic use. Conclusion: Antibiotic administration at our center was most common in ESG and sleeve revision procedures, potentially due to the perception of more full thickness suture bites than TORe procedures. Antibiotic use was not found to be associated with an increased risk of admission or adverse events after undergoing an EBT procedure. Given these findings, prophylactic antibiotics may not be necessary for EBT. However, larger prospective studies are required to validate these findings and to help standardize management.Table 1.: Prophylactic antibiotic use effect on patient outcomes and hospitalization. Endoscopic sleeve gastroplasty (ESG), Transoral outlet reduction (TORe), Transoral outlet reduction and gastroplasty (TORe-G). *Patients with unplanned readmission within 72 hours.