Year 2023 / Volume 115 / Number 7
Original
The volume of ERCP per endoscopist is associated with a higher technical success and a lower post-ERCP pancreatitis rate. A prospective analysis

368-373

DOI: 10.17235/reed.2022.9056/2022

Juan J. Vila, Amaia Arrubla Gamboa, Vanesa Jusué, Fermín Estremera-Arévalo, Belén González de la Higuerra, Juan Carrascosa Gil, Irene Rodríguez Mendiluce, Nerea Hervás, Carlos Prieto, Marta Gómez Alonso, Ignacio Fernández-Urién, Berta Ibáñez Beroiz,

Abstract
Introduction: conflicting results have been reported regarding the influence of the annual volume of endoscopic retrograde cholangiopancreatography (ERCP) on outcome. Objective: to evaluate the influence of case volume on ERCP outcomes. Patients and methods: an analysis of a prospective database was performed, comparing the outcomes of ERCP in three consecutive periods defined by the number of endoscopists performing ERCP: five endoscopists in period I (P1), four in period II (P2) and three in period III (P3). Only patients with biliary ERCP in accessible and naïve papilla were included. Primary variables were cannulation rates and adverse effects (AE). The American Society of Gastrointestinal Endoscopy (ASGE) complexity grades III and IV were considered as highly complex procedures. Results: a total of 2,561 patients were included: 727 (P1), 972 (P2) and 862 (P3). There were no differences in age and sex between groups (p > 0.05). The cannulation rate was significantly higher in P2 and P3: 92.4 % vs 93.3 % vs 93 % (p = 0.037). The AE rate was 13.8 %, 12.6 % and 10.3 % (p > 0.05), respectively. The rate of post-ERCP pancreatitis was significantly lower in P3: 8.5 %, 7.3 % and 5 % (p = 0.01). The rate of complex procedures was 12 %, 14.8 % and 27 % (p < 0.0001), respectively. Two endoscopists participated in all periods and only one had significantly improved outcomes. Cannulation and post-ERCP pancreatitis rates remained significantly better in P3 after adjusting for sex, complexity and endoscopist. Conclusion: a higher annual volume of ERCP per endoscopist was associated with a higher rate of cannulation and a lower rate of post-ERCP pancreatitis, despite the greater complexity of the procedures. These beneficial effects seem to differ between endoscopists.
Lay Summary
This study analyzed how the annual volume of Endoscopic Retrograde Cholangio-Pancreatography (ERCP) influences outcomes in a hospital. Three periods were compared in which the number of endoscopists performing this technique was reduced and therefore more ERCP volume was allocated to each endoscopist. We analyzed the outcomes of 2561 ERCPs in patients with intact papilla and found that the success rate was worse in the period with more endoscopists, while the rate of adverse events and post-ERCP pancreatitis was lower in the period with less endoscopists. The benefit of higher annual ERCP volume was not consistent across all endoscopists. In summary, this study indicates better ERCP outcomes when endoscopists perform a greater number of these techniques.
Share Button
New comment
Comments
No comments for this article
References
1. Berry R, Han JY, Tabibian JH. Difficult biliary cannulation: Historical perspective, practical updates, and guide for the endoscopist. World J Gastrointest Endosc. 2019;11(1):5-21. doi:10.4253/wjge.v11.i1.5
2. Birkmeyer NJO, Dimick JB, Share D, et al. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304(4):435-442. doi:10.1001/jama.2010.1034
3. Kapral C, Duller C, Wewalka F, Kerstan E, Vogel W, Schreiber F. Case volume and outcome of endoscopic retrograde cholangiopancreatography: results of a nationwide Austrian benchmarking project. Endoscopy. 2008;40(8):625-630. doi:10.1055/s-2008-1077461
4. Testoni PA, Mariani A, Giussani A, et al. Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study. Am J Gastroenterol. 2010;105(8):1753-1761. doi:10.1038/ajg.2010.136
5. Petersen BT. ERCP outcomes: Defining the operators, experience, and environments. Gastrointest Endosc. 2002;55(7):953-958. doi:10.1067/mge.2002.123622
6. Coté GA, Keswani RN, Jackson T, et al. Individual and practice differences among physicians who perform ERCP at varying frequency: a national survey. Gastrointest Endosc. 2011;74(1):65-73.e12. doi:10.1016/j.gie.2011.01.072
7. Lee TH, Bang BW, Park S-H, Jeong S, Lee DH, Kim S-J. Precut fistulotomy for difficult biliary cannulation: is it a risky preference in relation to the experience of an endoscopist? Dig Dis Sci. 2011;56(6):1896-1903. doi:10.1007/s10620-010-1483-z
8. Liao C, Thosani N, Kothari S, Friedland S, Chen A, Banerjee S. Radiation exposure to patients during ERCP is significantly higher with low-volume endoscopists. Gastrointest Endosc. 2015;81(2):391-8.e1. doi:10.1016/j.gie.2014.08.001
9. Cotton PB, Eisen G, Romagnuolo J, et al. Grading the complexity of endoscopic procedures: results of an ASGE working party. Gastrointest Endosc. 2011;73(5):868-874. doi:10.1016/j.gie.2010.12.036
10. ASGE Standards of Practice Committee, Anderson MA, Fisher L, et al. Complications of ERCP. Gastrointest Endosc. 2012;75(3):467-473. doi:10.1016/j.gie.2011.07.010
11. Dumonceau J-M, Andriulli A, Deviere J, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy. 2010;42(6):503-515. doi:10.1055/s-0029-1244208
12. Dumonceau J-M, Andriulli A, Elmunzer BJ, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated June 2014. Endoscopy. 2014;46(9):799-815. doi:10.1055/s-0034-1377875
13. ASGE STANDARDS OF PRACTICE COMMITTEE, Banerjee S, Shen B, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc. 2008;67(6):791-798. doi:10.1016/j.gie.2008.02.068
14. ASGE Standards of Practice Committee, Khashab MA, Chithadi K V, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc. 2015;81(1):81-89. doi:10.1016/j.gie.2014.08.008
15. Akaraviputh T, Lohsiriwat V, Swangsri J, Methasate A, Leelakusolvong S, Lertakayamanee N. The learning curve for safety and success of precut sphincterotomy for therapeutic ERCP: a single endoscopist’s experience. Endoscopy. 2008;40(6):513-516. doi:10.1055/s-2007-995652
16. Lee HJ, Cho CM, Heo J, et al. Impact of Hospital Volume and the Experience of Endoscopist on Adverse Events Related to Endoscopic Retrograde Cholangiopancreatography: A Prospective Observational Study. Gut Liver. 2020;14(2):257-264. doi:10.5009/gnl18537
17. Keswani RN, Qumseya BJ, O’Dwyer LC, Wani S. Association Between Endoscopist and Center Endoscopic Retrograde Cholangiopancreatography Volume With Procedure Success and Adverse Outcomes: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2017;15(12):1866-1875.e3. doi:10.1016/j.cgh.2017.06.002
18. Tyberg A, Sharaiha RZ, Kedia P, et al. EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study. Gastrointest Endosc. 2017;85(1):164-169. doi:10.1016/j.gie.2016.07.030
19. Li JW, Ang TL, Kam JW, Kwek ABE, Teo EK. The learning curve for needle knife precut sphincterotomy revisited. United Eur Gastroenterol J. 2017;5(8):1116-1122. doi:10.1177/2050640617701808
20. Williams EJ, Ogollah R, Thomas P, et al. What predicts failed cannulation and therapy at ERCP? Results of a large-scale multicenter analysis. Endoscopy. 2012;44(7):674-683. doi:10.1055/s-0032-1309345
21. Kawakami H, Maguchi H, Mukai T, et al. A multicenter, prospective, randomized study of selective bile duct cannulation performed by multiple endoscopists: the BIDMEN study. Gastrointest Endosc. 2012;75(2):362-372, 372.e1. doi:10.1016/j.gie.2011.10.012
22. Riesco-López JM, Vázquez-Romero M, Rizo-Pascual JM, et al. Efficacy and safety of ERCP in a low-volume hospital. Rev Esp Enferm Dig. 2013;105(2):68-73. doi:10.4321/s1130-01082013000200002
23. Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001;54(4):425-434. doi:10.1067/mge.2001.117550
24. Parsons HM. What Happened at Hawthorne?: New evidence suggests the Hawthorne effect resulted from operant reinforcement contingencies. Science. 1974;183(4128):922-932. doi:10.1126/science.183.4128.922
Related articles

Letter

A ghost epigastric pain

DOI: 10.17235/reed.2024.10500/2024

Digestive Diseases Image

Traumatic biliary fistula with bile duct disconnection

DOI: 10.17235/reed.2024.10096/2023

Editorial

Safe use of proton-pump inhibitors

DOI: 10.17235/reed.2023.9834/2023

Letter

Pseudo-submucosal tumor in the colon: seeing is believing

DOI: 10.17235/reed.2023.9773/2023

Letter

Hematoma post-endoscopic retrograde cholangiopancreatography

DOI: 10.17235/reed.2023.9670/2023

Editorial

Fewer endoscopists should perform more ERCPs

DOI: 10.17235/reed.2023.9507/2022

Digestive Diseases Image

Endosonographic and ERCP findings in COVID-19 critical illness cholangiopathy

DOI: 10.17235/reed.2022.9218/2022

Letter

Basic training in gastrointestinal endoscopy: recording images

DOI: 10.17235/reed.2020.7385/2020

Digestive Diseases Image

Cholangiohydatidosis: an uncommon cause of acute cholangitis

DOI: 10.17235/reed.2020.7063/2020

Review

Device-assisted enteroscopy training. A rapid review

DOI: 10.17235/reed.2020.6923/2020

Digestive Diseases Image

A rare cause of extrahepatic biliary tract stricture: a neuroendocrine carcinoma

DOI: 10.17235/reed.2020.6491/2019

Case Report

Pancreatobiliary maljunction: association with gallbladder cancer

DOI: 10.17235/reed.2019.6127/2018

Letter

Obstructive jaundice of a parasitic etiology

DOI: 10.17235/reed.2018.5827/2018

Original

Accuracy of ASGE criteria for the prediction of choledocholithiasis

DOI: 10.17235/reed.2016.4212/2016

Citation tools
Vila J, Arrubla Gamboa A, Jusué V, Estremera-Arévalo F, González de la Higuerra B, Carrascosa Gil J, et all. The volume of ERCP per endoscopist is associated with a higher technical success and a lower post-ERCP pancreatitis rate. A prospective analysis. 9056/2022


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 2646 visits.
This article has been downloaded 168 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 04/07/2022

Accepted: 25/07/2022

Online First: 31/08/2022

Published: 06/07/2023

Article revision time: 17 days

Article Online First time: 58 days

Article editing time: 367 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology