Patient‐related factors associated with successful cannulation by trainees during hands‐on endoscopic retrograde cholangiopancreatography training

Abstract

Background and Aim Hands‐on endoscopic retrograde cholangiopancreatography (ERCP) training is essential for trainees to grasp the technique. Cannulation success rate (CSR) is considered one of the main indicators of competency of trainees. We aimed to investigate whether patient‐related factors had an impact on the CSR of trainees. Methods A post hoc analysis of data from two multicenter studies (NCT02002650 and NCT03057769) was conducted. Patients aged 18–90 years with native papilla undergoing ERCP were eligible for this study. Only procedures involving trainees in centers strictly following “10‐min criteria” for initial cannulation were enrolled. Primary outcome was CSR by trainees. Results From December 2013 to October 2017, 20 trainees in four centers were involved in initial cannulation in 1044 patients with native papilla. Primary CSR by trainees was 61.0% (436/715), 31.5% (70/222) and 44.9% (48/107) in patients with common bile duct stone (CBDS), biliary stricture (BS) and other indications, respectively (P < 0.001). In multivariate analysis, indication of BS (OR, 0.31; 95% CI, 0.22–0.44; P < 0.001) and presence of type A diverticulum (OR, 1.69; 95% CI, 1.23–2.33; P = 0.001) were both independently associated with cannulation success of trainees. Biliary infection was significantly higher in the BS than in the CBDS group (3.6% vs 0.7%, P = 0.004), whereas other post‐ERCP complications were comparable between the two groups. Conclusions Indication of BS and the presence of type A diverticulum were independently associated with the success of cannulation by trainees. These findings indicate that greater effort is needed for trainees to improve the ability of cannulation in BS.

Relationship between papilla‐related variables and post endoscopic retrograde cholangiopancreatography pancreatitis: A multicenter, prospective study

“…16 PAD was termed as type A when the opening of a papilla was located outside the edge of diverticulum or type B when the opening was within the edge of diverticulum, as described previously. 9 Outcomes. The primary outcome was the incidence of PEP.…”

“…A type II duodenal stricture was considered if the stenosis was present in the descending part 16 . PAD was termed as type A when the opening of a papilla was located outside the edge of diverticulum or type B when the opening was within the edge of diverticulum, as described previously 9 …”

“…[2][3][4][5][6] The procedure of cannulation as well as PEP may be influenced by types of disease, the experience of endoscopists and the anatomy of papilla. 2,4,[7][8][9] Certain types of papilla are associated with difficult cannulation, such as a hooknose-shaped 10 or long protruding papilla. 11,12 Watanabe et al proposed a new morphology classification of papilla based on oral protrusion pattern, and retrospective analysis showed that large protruding papilla was an independent high-risk factor for difficult biliary cannulation.…”

“…A difficult cannulation, defined by prolonged cannulation time, more cannulation attempts, or inadvertent peritoneal dialysis (PD) insertion, has been recognized as a risk factor for PEP 2–6 . The procedure of cannulation as well as PEP may be influenced by types of disease, the experience of endoscopists and the anatomy of papilla 2,4,7–9 …”

Difficult biliary cannulation in ERCP procedures with or without trainee involvement: a comparative study

“…As time goes on during ERCP training, trainees could become more and more familiar with the cannulation of the native papilla. The rates of difficult or failed cannulation in trainee-involved ERCP may thus be different in early-stage vs. latestage of training, which had been revealed by several studies[15][16][17][18]. The definition of difficult cannulation in trainee involved procedures may be influenced by the learning curve effect.…”