Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training?

Abstract

Background/Aims: Cholangiogram interpretation is not used as a key performance indicator (KPI) of endoscopic retrograde cholangiopancreatography (ERCP) training, and national societies recommend different minimum numbers per annum to maintain competence. This study aimed to determine the relationship between correct ERCP cholangiogram interpretation and experience. Methods: One hundred fifty ERCPists were surveyed to appropriately interpret ERCP cholangiographic findings. There were three groups of 50 participants each: "Trainees, " "Consultants Group 1" (performed >75 ERCPs per year), and "Consultants Group 2" (performed >100 ERCPs per year). Results: Trainees was inferior to Consultants Groups 1 and 2 in identifying all findings except choledocholithiasis outside the intrahepatic duct on the initial or completion/occlusion cholangiogram. Consultants Group 1 was inferior to Consultants Group 2 in identifying Strasberg type A bile leaks (odd ratio [OR] 0.86, 95% confidence interval [CI] 0.77-0.96), Strasberg type B (OR 0.84, 95% CI 0.74-0.95), and Bismuth type 2 hilar strictures (OR 0.81, 95% CI 0.69-0.95). Conclusions: This investigation supports the notion that cholangiogram interpretation improves with increased annual ERCP case volumes. Thus, a higher annual volume of procedures performed may improve the ability to correctly interpret particularly difficult findings. Cholangiogram interpretation, in addition to bile duct cannulation, could be considered as another KPI of ERCP training.

UK ERCP sedation practices, patient comfort and endoscopist characteristics: National Endoscopy Database (NED) analysis on behalf of the JAG and BSG

“…The BSG’s ‘ERCP—the way forward’ framework recommends that each endoscopist performs a minimum of 75 ERCPs per year, with each trust performing at least 150 ERCPs. Multiple studies have demonstrated a direct correlation between an endoscopist’s annual volume of ERCPs and reported outcomes, including technical success rates, complication rates and length of hospital stay 18 19. High-volume centres have higher procedure success rates and shorter hospital stays 20 21…”