Advanced skills for general surgeons and carving out a niche: Endoscopic retrograde cholangiopancreatography in regional Australia

Abstract

Background The provision of high‐quality healthcare in rural Australian hospitals has necessitated general surgeons to take up the challenge and expand their expertise to advanced endoscopy techniques including endoscopic retrograde cholangiopancreatography (ERCP). This study examines the utility of ERCP in a regional setting especially in decreasing patient transfers and associated costs while achieving exceptional safety by measuring key indicators of safety and efficacy. Methods A single‐centre retrospective cross‐sectional cohort review in a rural Queensland hospital of patients who underwent ERCP (emergent and elective) from January 2019 until July 2022. Standardized international ERCP performance indicators were collected and compared to benchmark literature values including the rate of cannulation, stone extraction, successful stent placement, and post‐ERCP pancreatitis. Results The majority of the ERCP performance indicator benchmarks were met. 100% of patients had an appropriate indication for the procedure and consent. 98.95% successful CBD cannulation with only 14.14% requiring multiple attempts. 92.22% successful stone retrieval with 100% stent placement, well above guideline targets. The post‐procedural complication rate was 6.81% (2.09% pancreatitis; 1.05% pancreatitis; 1.05% duodenal perforation). Antibiotic prophylaxis adherence was identified to require improvement (12.57%). Conclusion High‐quality ERCP procedures can be performed in a regional hospital by general surgeons in a safe and cost‐effective manner, significantly decreasing the costs associated with patient transfer. This study reflects strong evidence for consistently achieving international ERCP performance benchmarks and the provision of high‐quality healthcare by a regional hospital and provides a strong argument for increasing access to ERCP in rural and remote hospitals.

Choledocholithiasis: A Review of Management and Outcomes in a Regional Setting

“…Management of choledocholithiasis in regional settings can often be challenging due to limited access to sub-specialist care, which may limit a health network's ability to provide quick access to specialized procedures. A recent review of 191 consecutive patients [18] who had an ERCP performed by a trained general surgeon in a regional center found that the procedure was completed well above published standards and was cost-effective when comparing overall management costs. Furthermore, despite perceived difficulties surrounding a CBDE, Hodgson et al [19] reported that a caseload of 70 CBDE over 10 years was sufficient in producing an 80% success rate, with only one procedure a year needed to maintain a safe procedure with a 50% success rate.…”