{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 29, Ep 4 of 4: Antibiotics, Devices, Capsule, and Adverse Events","html":"","width":"100%","height":180,"duration":1127,"description":"Episode four closes the chapter on four topics that each test one recognition: when the reflexive answer is wrong because the underlying principle has shifted. Antibiotic prophylaxis turns on closed-space infection, not the prosthetic device, so the 2007 AHA guideline took GI endoscopy off the endocarditis list. Cardiac device management turns on electromagnetic interference, so modern pacemakers tolerate routine polypectomy without reprogramming while ICDs need arrhythmia detection suspended. Capsule endoscopy lives or dies on retention risk addressed by the patency capsule, and the ASGE Cotton lexicon grades adverse events by intensity of intervention.\n \nTopics covered\n\nEndocarditis prophylaxis off the GI list\nThe closed-space infection principle\nIncomplete ERCP drainage and cyst FNA prophylaxis\nPacemakers and monopolar electrosurgery\nICDs and arrhythmia detection\nCapsule endoscopy retention\nThe patency capsule workup\nThe ASGE Cotton adverse event lexicon\n \n \nKey decisions\n\nGive no endocarditis prophylaxis for GI endoscopy, including prosthetic valves, pacemakers, ICDs, prosthetic joints, and vascular grafts, because the transient bacteremia risk is too low to justify antibiotics.\nReserve prophylaxis for closed-space scenarios: incomplete biliary drainage at ERCP, EUS-FNA of cystic lesions, PEG or PEJ placement with a single dose of cefazolin, cirrhotic UGI bleeding with ceftriaxone, and PD-patient lower endoscopy.\nWithhold prophylaxis for solid-lesion EUS-FNA, diagnostic EGD and colonoscopy, and non-bleeding variceal band ligation, because none creates a closed space the immune system cannot clear.\nDo not reprogram pacemakers for routine polypectomy; place the grounding pad away from the heart on the thigh or lower back, and add backup pacing only for the pacemaker-dependent patient in the cardiac field.\nSuspend ICD arrhythmia detection with a magnet or formal reprogramming during electrosurgery, leaving the pacing function untouched and placing external...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}