Prophylactic antibiotics after peroral endoscopic myotomy may not significantly reduce postprocedural fever or infection: a propensity score matching analysis.

BACKGROUND: Peroral endoscopic myotomy (POEM) has become a standard treatment for achalasia. Routine prophylactic antibiotics are still widely used after POEM, although clinical evidence supporting this common practice remains limited. This study aims to evaluate the clinical necessity of routine postoperative prophylactic antibiotics in patients with achalasia undergoing POEM. METHODS: We conducted a retrospective analysis of 340 achalasia patients who underwent POEM at the First Affiliated Hospital of Nanchang University between January 2012 and December 2024. Based on postoperative prophylactic antibiotic use, patients were divided into two groups: the prophylactic antibiotic (PA) group and the non-prophylactic antibiotic (non-PA) group. To minimize selection bias, 1:1 propensity score matching (PSM) was performed with a caliper of 0.1. RESULTS: In the overall cohort, patients were divided into PA group (n = 279, 82.1%) and non-PA group (n = 61, 17.9%). After matching, the baseline characteristics of the 56 patients in the PA group were well-balanced with those of the 56 patients in the non-PA group (all p > 0.05). There were no significant differences between the two groups in the incidence of postprocedural fever, infection or the median length of hospital stay (p > 0.05). In the full-thickness myotomy subgroup, there were no significant differences between the two groups in the incidence of postprocedural fever and infection. However, the incidence of cough was significantly higher in the non-PA group compared to the PA group (p = 0.040). CONCLUSION: Routine prophylactic antibiotics after POEM for patients with achalasia may not significantly reduce postprocedural fever, infection, or length of hospital stay.