# Digestive and bariatric surgery, digestive endoscopy and interventional radiology

Raphaël Cinotti, Eric Bonnet, Frédéric Borie, Niki Christou, Justine Demay, Hervé Dupont, Laure Fieuzal, Aurélie Gouel, David Karsenti, Hicham Kobeiter, et al.

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## To cite this version:

Raphaël Cinotti, Eric Bonnet, Frédéric Borie, Niki Christou, Justine Demay, et al. Digestive and bariatric surgery, digestive endoscopy and interventional radiology. Anaesthesia Critical Care & Pain Medicine, 2026, pp.101757. 10.1016/j.accpm.2026.101757. hal-05490485

HAL Id: hal-05490485

https://hal.science/hal-05490485v1

Submitted on 3 Feb 2026

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Distributed under a Creative Commons CC BY 4.0 - Attribution - International License
Digestive and bariatric surgery, digestive endoscopy and
interventional radiology

Raphaël Cinotti ¹, Eric Bonnet ², Frédéric Borie ³, Niki Christou ⁴, Justine Demay ⁵, Hervé Dupont ⁶, Laure Fieuzal ⁵, Aurélie Gouel ⁷, David Karsenti ⁸, Hicham Kobeiter ⁹, Emilie Lermitte ¹⁰, Céline Monard ¹¹, Philippe Montravers ¹², Jérome Morel ¹³, David Moskowicz ¹⁴, Pablo Ortega-Deballon ¹⁵, Bruno Pastene ¹⁶, Nelly Rondeau ¹⁷, Charles Sabbagh ¹⁸, Lilian Schwarz ¹⁹, Regis Souche ²⁰, Julie Veziant ²¹, Audrey De Jong ²², Emmanuel Weiss ²³

¹ CHU Nantes, Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France.

² CHU Toulouse, Department of Infectious Diseases, Hôpital Joseph Ducuing, Toulouse, France.

³ CHU Caremeau, Department of Digestive Surgery, Nîmes University Hospital, University of Montpellier, Nîmes, France.

⁴ CHU Limoges, Department of Digestive Surgery, CHU de Limoges, 87042 Limoges cedex, France.

⁵ CHU Nantes, CHU de Nantes - Hôtel Dieu, 1 place Alexis Ricordeau 44000 Nantes, France.

⁶ CHU Amiens Picardie, Anesthesia and critical care department, Amiens Hospital University, F-80054 Amiens, France.

⁷ Hôpital Bichat-Claude BernardHôpital Bichat - Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France.

⁸ Clinique Paris-Bercy, Digestive Endoscopy Unit, Clinique Paris-Bercy, Charenton-le-Pont, France.

⁹ Hôpital Henri-Mondor, Department of Diagnostic and Interventional Medical Imaging, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Université Paris Est, 94000 Créteil, France.

¹⁰ CHU Angers, Service de Chirurgie Digestive, University Hospital of Angers, Angers, France.

¹¹ Service d'anesthésie-réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.

¹² CHU Bichat Claude Bernard, Université Paris Cité, Paris, France; Thoracic, Vascular & Lung Transplant Surgery Department, AP-HP.Nord, Hôpital Bichat-Claude Bernard, Paris, France.

¹³ CHU Saint-Etienne, Département d'Anesthésie et Réanimation, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France.
14 Hopital Louis-Mourier, Université Paris Cité, Service de Chirurgie Digestive, Hôpital Louis-Mourier, DMU ESPRIT- GHU AP-HP Nord-Université Paris Cité, Colombes, France.

15 CHU Bocage Central Dijon, Department of Abdominal and Visceral Surgery, François-Mitterrand University Hospital, Dijon, France.

16 CHU Marseille, Department of Anaesthesia and Intensive Care, North Hospital, Marseille, France.

17 Clinique Jules Vernes Nantes, Service Anesthésie-Réanimation, Hôpital Guillaume et René Laennec, Boulevard Jacques Monod, Centre Hospitalo-Universitaire, 44093 cedex Nantes, France.

18 CHU Amiens, Department of Digestive Surgery, Amiens University Hospital, Amiens, France.

19 CHU Rouen, Department of Digestive Surgery, Rouen University Hospital, France.

20 CHU Montpellier, Department of Surgery, Hopital Saint Eloi, Montpellier, France.

21 CHU Lille, Department of Digestive and Oncological Surgery, Claude Huriez Hospital, Chu Lille, Lille, France.

22 CHU Montpellier, Intensive Care Unit, Anesthesia and Critical Care Department (DAR-B), Saint Eloi Teaching Hospital, University of Montpellier, Research Unit: PhyMedExp, INSERM U-1046, CNRS, 1, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France.

23 Hôpital Beaujon, Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris, France. Electronic address: emmanuel.weiss@aphp.fr.

In case of true allergy to beta-lactam if antibiotic prophylaxis is indicated:

Instead of cefazolin: Vancomycin 20mg/kg Slow IV or Teicoplanine 12mg/kg Slow IV

Instead of cefoxitin: gentamicin 6 to 7 mg/kg Slow IV + metronidazole 1g Slow IV

*Correspondence:

Emmanuel Weiss, emmanuel.weiss@aphp.fr
ESOPHAGOGASTRIC, SMALL BOWEL, COLORECTAL AND PROCTOLOGIC SURGERY

Surgery of the digestive tract and/or its annexes corresponds to either clean surgery (class I of the Altemeier wound classification) in the absence of opening of the digestive tract, or more commonly to clean-contaminated surgery (class II of the Altemeier wound classification) when the digestive tract is opened. Laparoscopic-surgery follows the same principles of open surgery, as the approach is the only difference for the same intervention. In case of conversion to laparotomy, the management of the risk of infection remains unchanged. Obesity surgery, also known as bariatric surgery, aims to modify the anatomy of the digestive system. It is a mechanical and metabolic aid that makes it possible to reduce the amount of food consumed (principle of restriction) and/or the assimilation of food by the body (principle of malabsorption). Morbid obesity is an important risk factor for surgical site infections (SSIs), and antibioprophylaxis is recommended regardless of whether the digestive tract is opened and irrespective of the approach used. Dosage adjustments in obese patients undergoing bariatric surgery (as in any other surgery) are discussed in field 1, R1.5 and R1.6. Colorectal and proctologic surgery corresponds to clean-contaminated surgery (class II of the Altemeier wound classification).

* Up to a BMI ≤ 50 kg/m2, it is important to respect the reinjection intervals (see Field 1, R1.5). Beyond this, a different strategy may be discussed collegially, based either on increasing the unit dose (4g), or on shortening the reinjection interval in case of discontinuous administration, or on the use of a maintenance dose in continuous intravenous infusion during the procedure.

** In the absence of available studies regarding the use of cefuroxime in this indication, this molecule is not proposed as an alternative for this surgery.

*** GRADE 1 applies: i. to the administration of antibiotic prophylaxis in colorectal surgery ii.to the fact that this antibiotic prophylaxis should include both oral administration the evening before and intravenous administration during the intervention

**** Tobramycin (Nebcine®, non-generic), for which only intravenous (IV) or inhaled forms are currently available in France, is used off-label here by oral administration. 100 mg vials are available in hospitals or retail pharmacies. The use of the IV form by oral administration does not result in absorption of the molecule but exerts a digestive decontamination activity. Among the notable excipients, the presence of sulfites requires verification of the absence of a true sulfite allergy (as for IV administration), in addition to a true allergy to tobramycin. Off-label use requires, in theory, prior agreement from the CPAM for the patient to be reimbursed. Mentioning these recommendations in the prescription (see model prescription in the appendix on the SFAR website) could allow the patient to be reimbursed, but without guarantee. Therefore, the patient should be informed, if it is decided not to obtain prior agreement, that the cost could be charged to them (price from the OCP wholesaler-distributor in December 2023: €3.05 per 100 mg vial). For information, oral metronidazole is available in boxes of 4 tablets of 500 mg, a packaging option that should be favored to avoid dispensing more doses than will be used by the patient (cost in December 2023: €1.31 per box of 4 tablets of 500 mg)
***** ESBL: Extended-Spectrum Beta-Lactamase. It is recommended that screening be performed in the month preceding surgery in centers where the prevalence reaches or exceeds 10% of patients carrying ESBL-producing Enterobacteriaceae (R1.7). In addition, targeted screening may be considered for patients with a history of colonization or infection with ESBL-producing Enterobacteriaceae in the past 6 months.

<table><thead><tr><th>Surgical or interventional procedures</th><th>Molecules</th><th>Initial dose</th><th>Reinjections and duration</th><th>Strength of recommendation</th></tr></thead><tbody><tr><td colspan="5">Esophageal surgery (with or without coloplasty)</td></tr><tr><td rowspan="2">Esophagectomy<br>Excision of esophageal tumor<br>Treatment of esophageal diverticulum</td><td>Cefazolin</td><td>2g Slow IV</td><td>1g if duration > 4 hours, then every 4 hours until the end of surgery</td><td rowspan="2">●●● (Expert opinion)</td></tr><tr><td>Alternative :<br>Cefuroxime</td><td>1,5 g slow IV</td><td>0.75g if duration > 2 hours, then every 2 hours until the end of surgery</td></tr><tr><td colspan="5">Non-bariatric gastric surgery</td></tr><tr><td rowspan="2">Total gastrectomy<br>Partial gastrectomy</td><td>Cefazolin</td><td>2g Slow IV</td><td>1g if duration > 4 hours, then every 4 hours until the end of surgery</td><td rowspan="2">●●● (Expert opinion)</td></tr><tr><td>Alternative :<br>Cefuroxime</td><td>1,5 g slow IV</td><td>0.75g if duration > 2 hours, then every 2 hours until the end of surgery</td></tr><tr><td colspan="5">Bariatric surgery</td></tr><tr><td>Gastric banding</td><td>Cefazolin</td><td>2g Slow IV</td><td>1g if duration > 4 hours, then every 4 hours until the end of surgery</td><td>●●● (Expert opinion)</td></tr><tr><td>Gastric by-pass or sleeve gastrectomy</td><td>Cefoxitin</td><td>2g Slow IV</td><td>1g if duration > 2 hours, then every 2 hours until the end of surgery</td><td>●●● (Expert opinion)</td></tr><tr><td colspan="5">Small bowell surgery</td></tr><tr><td>Small bowel resection<br>Enterostomy</td><td>Cefoxitin</td><td>2g Slow IV</td><td>1g if duration > 2 hours, then every 2 hours until the end of surgery</td><td>●●● (Expert opinion)</td></tr><tr><td colspan="5">Colorectal surgery and appendicectomy</td></tr></tbody></table>
<table><tbody><tr><td rowspan="2">Colectomy<br>Abdomino-perineal resection<br>Proctectomy<br>Restoration of continuity</td><td>The night before :</td><td></td><td></td><td>●●● (GRADE 1)</td></tr><tr><td>Tobramycin<br>+ Metronidazole</td><td>200 mg<br>1g</td><td>Single dose orally<br>Single dose orally</td><td>●●● (Expert opinion)</td></tr><tr><td></td><td>During surgery :<br>Cefoxitin</td><td>2g Slow IV</td><td>1g if duration > 2 hours, then every 2 hours until the end of surgery</td><td>●●● (GRADE 1)</td></tr><tr><td colspan="5">If rectal carriage of ESBL-producing Enterobacteriaceae is identified: antibioprophylaxis active against the identified strain(cf. R1.7) [●●● (Expert opinion)]</td></tr><tr><td>Delayed appendicectomy</td><td>Cefoxitin</td><td>2g Slow IV</td><td>1g if duration > 2 hours, then every 2 hours until the end of surgery</td><td>●●● (Expert opinion)</td></tr><tr><td colspan="5"><strong>Proctologic surgery</strong></td></tr><tr><td>Hemorrhoid surgery<br>Pylonidal cyst surgery<br>Anal fistula surgery</td><td>Metrodinazole</td><td>1g Slow IV</td><td>Single injection</td><td>●●● (Expert opinion)</td></tr></tbody></table>
HEPATO-BILIARY, SPLEEN AND PANCREATIC SURGERY

**Gallbladder and bile duct surgery:** patients with active bile duct infection during surgery are excluded from the scope of these recommendations. In case of a bile duct procedure in a patient at risk of bile duct colonization (especially patients with a bile duct prosthesis), antibiotic prophylaxis should be adapted to the patient's biliary infectious history. In the absence of documented infection or positive preoperative bile culture in these patients at risk of bile duct colonization, antibiotic prophylaxis with piperacillin + tazobactam 4g IV (Expert Opinion)

**Pancreatic surgery:** pancreatic surgery corresponds to clean-contaminated surgery (class 2 of Altemeier) due to the opening of the digestive tract for the realization of anastomoses, regardless of the approach (laparoscopy or laparotomy). Conversion to laparotomy is always possible and infectious complications are then identical.

**Liver and pancreas transplantation:** ISO affect 10 to 37% of liver transplant patients and 9 to 45% of pancreas transplant patients. They are serious and associated with an increased risk of graft loss and mortality. Many different bacteria are responsible for ISO: GNB (Enterobacteriaceae, Acinetobacter spp., Pseudomonas spp.) or GPC (Enterococcus, S. aureus, Coagulase-negative Staphylococcus). The incidence of MDR and Candida sp. in these infections is not negligible. The very large differences in practices in the different transplant centers and the absence of a robust randomized controlled trial do not allow to formulate high-level evidence recommendations. The systematic use of broad-spectrum molecules does not seem superior to the use of molecules with a narrower spectrum.

<table><thead><tr><th>Surgical or interventional procedures</th><th>Molecules</th><th>Initial dose</th><th>Reinjections and duration</th><th>Strength of recommendation</th></tr></thead><tbody><tr><td colspan="5"><strong>Gallbladder and bile duct surgery</strong></td></tr><tr><td rowspan="2">Elective laparoscopic cholecystectomy<br>o High-risk patients: Age &gt;80 years, pregnancy, immunosuppression, surgery performed immediately after acute cholecystitis, jaundice, common bile duct stone(s), stent placement, conversion to laparotomy, bile leak</td><td>Cefazolin</td><td>2g Slow IV</td><td>1g if duration &gt; 4 hours, then every 4 hours until the end of surgery</td><td>◎◎◎ (Expert opinion)</td></tr><tr><td>Alternative : Cefuroxime</td><td>1,5g Slow IV</td><td>0.75g if duration &gt; 2 hours, then every 2 hours until the end of surgery</td><td></td></tr><tr><td>Patients at low risk: None of the above criteria</td><td colspan="3">No antibiotic prophylaxis</td><td>◎◎◎ (GRADE 2)</td></tr></tbody></table>
<table><tbody><tr><td><ul><li>Open Cholecystectomy</li><li>Cholecystectomy with transcytic commun bile duct stones removal</li><li>Cholecystectomy with commun bile duct stones removal by cholecotomy</li><li>Laparoscopic or open common bile duct exploration</li></ul></td><td>Cefazolin</td><td>2g Slow IV</td><td>1g if duration > 4 hours, then every 4 hours until the end of surgery</td><td>©©© (Expert opinion)</td></tr><tr><td></td><td>Alternative: Cefuroxime</td><td>1,5g Slow IV</td><td>0.75g if duration > 2 hours, then every 2 hours until the end of surgery</td><td></td></tr><tr><td colspan="5"><strong>Bile duct-digestive anastomosis</strong></td></tr><tr><td>Cholecystectomy with choledoco-jejunostomy<br>Resection of the pedicular main bile duct with biliary-digestive anastomosis</td><td>Cefoxitin</td><td>2g Slow IV</td><td>1g if duration > 2 hours, then every 2 hours until the end of surgery</td><td>©©© (Expert opinion)</td></tr><tr><td colspan="5"><strong>Liver resection without bile duct surgery</strong></td></tr><tr><td>atypical liver resection (open or laparoscopic)<br>uni- bi or tri-segmentectomy of the liver (open or laparoscopic)<br>Left or right hepatectomy (open or laparoscopic)</td><td>Cefazolin</td><td>2g Slow IV</td><td>1g if duration > 4 hours, then every 4 hours until the end of surgery</td><td>©©© (Expert opinion)</td></tr><tr><td></td><td>Alternative: Cefuroxime</td><td>1,5g Slow IV</td><td>0.75g if duration > 2 hours, then every 2 hours until the end of surgery</td><td></td></tr><tr><td colspan="5"><strong>Simple liver cyst surgery</strong></td></tr><tr><td>Resection of the protruding dome<br>Peri-cystectomy<br>Hydatid cyst surgery</td><td>No antibiotic prophylaxis</td><td></td><td></td><td>©©© (Expert opinion)</td></tr><tr><td colspan="5"><strong>Splenectomy</strong></td></tr></tbody></table>
<table><tbody><tr><td>Scheduled or emergency splenectomy (Open or laparoscopic)</td><td>Cefazolin<br/>Alternative : Cefuroxime</td><td>2g Slow IV<br/>1,5g Slow IV</td><td>1g if duration > 4 hours, then every 4 hours until the end of surgery<br/>0.75g if duration > 2 hours, then every 2 hours until the end of surgery</td><td>●●● (Expert opinion)</td></tr><tr><td colspan="5"><strong>Pancreatic surgery</strong></td></tr><tr><td>• Left pancreatectomy with or without spleen preservation<br/>• Total or subtotal pancreatectomy with duodenal preservation<br/>• Pancreas-sparing procedures: pancreatic isthmectomy, tumor enucleation</td><td>Cefazolin<br/>Alternative : Cefuroxime</td><td>2g Slow IV<br/>1,5g Slow IV</td><td>1g if duration > 4 hours, then every 4 hours until the end of surgery<br/>0.75g if duration > 2 hours, then every 2 hours until the end of surgery</td><td>●●● (GRADE 2)</td></tr><tr><td>Pylorus-preserving pancreaticoduodenectomy (PPPD) without preoperative biliary drainage<br/>Total pancreatectomy (TP) without preoperative biliary drainage</td><td>Cefoxitin</td><td>2g Slow IV</td><td>1g if duration > 2 hours, then every 2 hours until the end of surgery</td><td>●●● (GRADE 1)</td></tr><tr><td>PPPD or TP for Ampulloma or with a history of preoperative biliary drainage or sphincterotomy</td><td>Piperacillin + tazobactam</td><td>4g Slow IV</td><td>4g if duration > 4 hours, then every 4 hours until the end of surgery</td><td>●●● (GRADE 2)</td></tr><tr><td colspan="5"><strong>Liver and pancreas transplantation</strong></td></tr><tr><td>Liver transplantation (total)<br/>Liver transplantation (reduced)<br/>Pancreas transplantation</td><td>Cefoxitin</td><td>2g Slow IV</td><td>1g if duration > 2 hours, then every 2 hours until the end of surgery</td><td>●●● (Expert opinion)</td></tr></tbody></table>
<table><tr><td>Simultaneous pancreas-kidney transplantation</td><td>Spectrum to be broadened and/or adapted to local ecology if risk factors for multidrug-resistant bacteria and/or history of fungal infection[@@@ (Expert opinion)]</td></tr></table>

## ABDOMINAL-WALL SURGERY

<table><thead><tr><th>Surgical or interventional procedures</th><th>Molecules</th><th>Initial dose</th><th>Reinjections and duration</th><th>Strength of recommendation</th></tr></thead><tbody><tr><td rowspan="2">Hernia repair (inguinal and femoral) with mesh (open or laparoscopic)</td><td>Cefazolin</td><td>2g Slow IV</td><td>1g if duration > 4 hours, then every 4 hours until the end of surgery</td><td rowspan="2">@@@ (GRADE 2)</td></tr><tr><td>Alternative : Cefuroxime</td><td>1,5g Slow IV</td><td>0.75g if duration > 2 hours, then every 2 hours until the end of surgery</td></tr><tr><td>Inguinal hernia repair without mesh</td><td colspan="3">No antibiotic prophylaxis</td><td>@@@ (GRADE 2)</td></tr></tbody></table>

## GASTROINTESTINAL ENDOSCOPY

<table><thead><tr><th>Surgical or interventional procedures</th><th>Molecules</th><th>Initial dose</th><th>Reinjections and duration</th><th>Strength of recommendation</th></tr></thead><tbody><tr><td colspan="5">Endoscopic retrograde cholangiopancreatography ERCP</td></tr><tr><td>Cholangiography<br>Pancreatography<br>Dilatation and stenting of biliary or pancreatic strictures with complete satisfactory drainage</td><td colspan="3">No antibiotic prophylaxis</td><td>@@@ (GRADE 1)</td></tr></tbody></table>
<table><tbody><tr><td>Cholangioscopy or pancreatoscopy, with or without lithotripsy<br>Dilation and stenting of biliary or pancreatic ducts with incomplete biliary drainage<br>Extraction of biliary or pancreatic stones, with or without mechanical lithotripsy, with incomplete biliary drainage</td><td>Cefoxitin</td><td>2g Slow IV</td><td>1g if duration > 2 hours, then every 2 hours until the end of surgery</td><td>●●○○ (Expert opinion)</td></tr><tr><td colspan="5">endoscopic ultrasound-guided fine needle aspiration</td></tr><tr><td>Puncture of pancreatic or extrapancreatic tissue lesion, para-oesophageal, para-gastric, para-duodenal or para-rectal</td><td colspan="3">No antibiotic prophylaxis</td><td>●●●○ (GRADE 2)</td></tr><tr><td>Percutaneous aspiration of pancreatic cystic lesion without risk factors for infection</td><td colspan="3">No antibiotic prophylaxis</td><td>●●○○ (Expert opinion)</td></tr><tr><td><ul><li>Puncture of pancreatic cystic lesion with risk factor(s) for infection related to the endoscopic procedure (intra-cystic bleeding, incomplete drainage of the cystic lesion after puncture) and/or the patient (immunosuppression context, or high risk of infective endocarditis)</li><li>Cystogastrostomy</li><li>Ascitic fluid puncture, with or without peritoneal nodule puncture (i.e. through the digestive tube)</li><li>Pleural fluid puncture (i.e. through the digestive tube)</li><li>Gastrojejunal anastomosis under echo-endoscopy</li></ul></td><td>Cefoxitin</td><td>2g Slow IV</td><td>Single injection</td><td>●●○○ (Expert opinion)</td></tr><tr><td colspan="5">Upper gastrointestinal endoscopy</td></tr></tbody></table>
<table><tr><td>Diagnostic<br>esophagogastroduodenoscopy, with or without biopsy<br>Therapeutic<br>esophagogastroduodenoscopy with dilation, or stent<br>placement, or mucosal<br>resection, or submucosal<br>dissection.</td><td colspan="3">No antibiotic prophylaxis</td><td>●●○○ (Expert opinion)</td></tr><tr><td>Percutaneous endoscopic<br>gastrostomy (PEG) tube<br>placement*</td><td>Cefazolin</td><td>2g Slow IV</td><td>Single injection</td><td>●●●○ (GRADE 1)</td></tr><tr><td>Sclerotherapy and/or ligation<br>of oesophageal-gastric<br>varices, outside of the<br>haemorrhagic period</td><td colspan="3">No antibiotic prophylaxis</td><td>●●○○ (Expert opinion)</td></tr><tr><td>Sclerotherapy and/or ligation<br>of oesophageal-gastric<br>varices during haemorrhage</td><td colspan="3">Ciprofloxacin 400 mg Slow IV x2/day, then switch to<br>oral administration after 48 hours if possible (or<br>norfloxacin oral 400 mg x2/day when reimbursed<br>again), for 7 days, EXCEPT:<br>In case of advanced cirrhosis (child B or C)<br>and/or patient hospitalized for more than 48 hours (due<br>to high prevalence of resistance to quinolones)<br>and/or patient treated with long-term quinolone<br>prophylaxis for infection regarding ascitic fluid<br>then Ceftriaxone 1g/24h IV for 7 days<br><br>* In case of beta-lactam allergy: multidisciplinary choice of a molecule and<br>its dose according to the often altered renal function in cirrhotic patients<br>[●●○○ Expert opinion]</td><td>●●●○ (GRADE 1)</td></tr><tr><td colspan="5">Lower gastrointestinal endoscopy</td></tr><tr><td>● Diagnostic colonoscopy,<br>with or without biopsy</td><td colspan="3">No antibiotic prophylaxis</td><td>●●○○ (Expert opinion)</td></tr><tr><td>● Colonoscopy with dilation,<br>or stent placement, or<br>mucosal resection, or<br>submucosal dissection</td><td colspan="3"></td><td></td></tr></table>

*Biliary drainage is considered incomplete in case of failed cannulation, persistence of stones, intra- or extrahepatic stenosis not stented, or non-optimal clearance at the end of the procedure according to the operator.

**If ascites separates the digestive tube from the punctured tissue lesion, then administer antibiotic prophylaxis according to the same modalities as for « peritoneal ascites puncture, with or without per-endoscopic nodule puncture. »
INTERVENTIONAL DIGESTIVE RADIOLOGY

<table><thead><tr><th>Surgical or interventional procedures</th><th>Molecules</th><th>Initial dose</th><th>Reinjections and duration</th><th>Strength of recommendation</th></tr></thead><tbody><tr><td colspan="5"><strong>Hepatic artery embolization</strong></td></tr><tr><td>Chemoembolization<br>Hepatic artery embolisation<br>Transjugular intrahepatic portosystemic shunt (TIPS)</td><td>No antibiotic prophylaxis</td><td></td><td></td><td>●●● (Expert opinion)</td></tr><tr><td colspan="5"><strong>Biliary interventional radiology</strong></td></tr><tr><td>Biliary drainage</td><td>No antibiotic prophylaxis</td><td></td><td></td><td>●●● (Expert opinion)</td></tr></tbody></table>
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