Outcome of ERCP related to case-volume

Abstract

Background and aims In some studies, high endoscopic retrograde cholangiopancreatography (ERCP) case-volume has been shown to correlate to high success rate in terms of successful cannulation and fewer adverse events. The aim of this study was to analyze the association between ERCP success and complications, and endoscopist and centre case-volumes. Methods Data were obtained from the Swedish National Register for Gallstone Surgery and ERCP (GallRiks) on all ERCPs performed for Common Bile Duct Stone (CBDS) (n = 17,873) and suspected or confirmed malignancy (n = 6152) between 2009 and 2018. Successful cannulation rate, procedure time, intra- and postoperative complication rates and post-ERCP pancreatitis (PEP) rate, were compared with endoscopist and centre ERCP case-volumes during the year preceding the procedure as predictor. Results In multivariable analyses of the CBDS group adjusting for age, gender and year, a high endoscopist case-volume was associated with higher successful cannulation rate, lower complication and PEP rates, and shorter procedure time (p < 0.05). Centres with a high annual case-volume were associated with high successful cannulation rate and shorter procedure time (p < 0.05), but not lower complication and PEP rates. When indication for ERCP was malignancy, a high endoscopist case-volume was associated with high successful cannulation rate and low PEP rates (p < 0.05), but not shorter procedure time or low complication rate. Centres with high case-volume were associated with high successful cannulation rate and low complication and PEP rates (p < 0.05), but not shorter procedure time. Conclusions The results suggest that higher endoscopist and centre case-volumes are associated with safer ERCP and successful outcome.

Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management

“…A large retrospective study found that a low case volume was a risk factor for post-ERCP pancreatitis in certain scenarios. Syrén et al 15 performed a retrospective analysis of 80,904 ERCPs in Sweden between 2009 and 2018. Endoscopists with higher case volumes were noted to have lower rates of PEP when ERCPs were performed for choledocholithiasis (OR, 1.028; 95% CI, 1.002–1.054) and malignancy (OR, 1.179; 95% CI, 1.045–1.330).…”

Incidental Discovery of a Phrygian Cap During Whipple's Procedure: A Case Report

“…A CBD stent can prevent further problems from arising and relieve symptoms like jaundice. The stent is usually implanted via an operation known as endoscopic retrograde cholangiopancreatography (ERCP), in which the bile ducts are accessed by passing a flexible tube equipped with a camera through the mouth, down the oesophagus, and into the stomach and small intestine [4].…”

“…Usually a benign anatomical variation, it might occasionally provide difficulties during gallbladder surgery or be linked to certain diseases like cholecystitis or gallstones [2,3]. A cholecystectomy, or surgical removal of the gallbladder, may be advised if the Phrygian cap is producing recurrent symptoms, complications such as gallstones or cholecystitis, or if there is a chance of issues in the future [4,8]. This can often be performed laparoscopically, which is less intrusive and heals more quickly than open surgery [3].…”

Validity of a virtual reality endoscopic retrograde cholangiopancreatography simulator: can it distinguish experts from novices?

“…Visceral perforation and bleeding are sometimes seen after ERCP, but the most feared complication is that of post-ERCP pancreatitis (PEP), with a rate of 3.5%–5% ( 1 ). It has been suggested that higher endoscopist case volumes are associated with safer ERCP and successful outcomes, and therefore, there is an urgent need to provide opportunities for hands-on training for all endoscopists and surgeons performing ERCP ( 2 , 3 ).…”