Efficacy and safety of ERCP in a low-volume hospital

Riesco-López, José María; Vázquez-Romero, Manuel; Rizo-Pascual, Juana María; Rivero-Fernández, Miguel; Manzano-Fernández, Rebeca; González-Alonso, Rosario; Moya-Valverde, Eloísa; Díaz-Sánchez, Antonio; Campos-Cantero, Rocío

doi:10.4321/s1130-01082013000200002

Cited by 13 publications

(8 citation statements)

References 42 publications

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“…Earlier I tried to show that ERCP success depends mainly on single-operator volume of procedures and skills, rather than total number of ERCPs performed in a hospital (15). Similar results were found by other colleagues (16). Something similar to ERCP had been reported for cardiovascular procedures.…”

supporting

confidence: 90%

If you suffer from type-2 diabetes mellitus, your ERCP is likely to have a better outcome

García-Cano

2016

Rev Esp Enferm Dig

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supporting

confidence: 90%

If you suffer from type-2 diabetes mellitus, your ERCP is likely to have a better outcome

García-Cano

2016

Rev Esp Enferm Dig

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“…It is important to underscore the fact that procedure-related outcomes from our cohort, both in terms of technical success and procedure-related adverse events, compared favorably with suggested quality standards, with a cannulation rate consistently above 85% and low-complication rates, even when trainees were involved. Also, the limited data available from studies of endoscopic practice just after the training period suggests that precut rates for endoscopists starting independent practice is above 10%, without compromising technical success and patient safety [28,29].…”

Section: Discussionmentioning

confidence: 99%

ERCP practice beyond the training period – bridging the gap between guidelines and real-life practice: a single operator experience of 679 procedures

Voiosu

Benguș

et al. 2019

Romanian Journal of Internal Medicine

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Background. Endoscopic retrograde cholangiopancreatography has evolved significantly in recent years. The increase in complexity and range of applications has not been adequately reflected in an improvement of training methods for ERCP, with many endoscopists failing to meet required performance standards during their training period and limited available data on their performance immediately after completing training. We aimed to analyze the performance of an independent operator from a developing country after the completion of formal training with regard to procedure and patient-related outcomes. Methods. We conducted an observational study of ERCPs performed by a young endoscopist from a referral center. Data about the procedure, cannulation technique (including use of precut), trainee involvement and procedure-related outcomes was retrieved and analyzed from a prospectively maintained database on quality in ERCP (the QUASIE initiative). Results. Data from 679 consecutive ERCPs conducted or supervised by one endoscopist with < 200 independent procedures prior to the study period were included in the final analysis. Cannulation rates significantly improved over time, from 90% to 96% (p = 0.016). Use of precut techniques changed significantly over time, with an initial increase followed by a subsequent decrease as overall cannulation rates improved. Trainee involvement was significantly associated with prolonged cannulation times (p = 0.003) and use of precut (p = 0.001), but did not impact on technical success or patient safety. Conclusions. Independent practice of ERCP after the training period is characterized by ongoing changes in technique, especially with regard to cannulation and use of precut, showing significant improvements in performance over time.

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“…However, what really matters is the number of ERCP procedures performed by each specific endoscopist. Ongoing personal commitment, study, and self-criticism improve the practice of such a complex procedure, and eventually provide very acceptable outcomes in low-volume centers (5).…”

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confidence: 99%

Pursuing excellence in ERCP

García-Cano

Domper²

2018

Rev Esp Enferm Dig

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The term "ERCP cannulation" returns 1,563 items in Pubmed. In 1980 there were 7 papers, and 92 were included in 2015. Any gastroenterologist knows ERCP is often a complex procedure, at times with uncertain results, that unfortunately leads every so often to lawsuits. Most issues derive from attempts at biliary cannulation, despite the improved instruments available since the days of the first sphincterotomy back in 1974. The initial priority goal of ERCP learning is a satisfactory rate of choledochal cannulation. Such rate has been somewhat arbitrarily set as at least 80% of successful biliary access.

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Efficacy and safety of ERCP in a low-volume hospital

Abstract: the results obtained after performing 200 procedures support the ability to practice ERCP in low-volume hospitals obtaining levels of efficacy and safety in accordance with published quality standards.

Cited by 13 publications

References 42 publications

If you suffer from type-2 diabetes mellitus, your ERCP is likely to have a better outcome

If you suffer from type-2 diabetes mellitus, your ERCP is likely to have a better outcome

ERCP practice beyond the training period – bridging the gap between guidelines and real-life practice: a single operator experience of 679 procedures

Pursuing excellence in ERCP

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