TP6.2.9 1224 Surgical Endoscopic Retrograde Cholangio-Pancreatography over three years. A single unit’s experience of service provision and delivery of clinical excellence

Abstract

Aims Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is traditionally the domain of medical gastro-enterology. Our practice is exclusively surgeon delivered and therefore represents an alternative paradigm. The British society of Gastro-enterology (BSG) proposed key performance indicators in 2014 to evaluate standards of ERCP practice with focus on performance and safety against which we evaluated our practice. Methods The study period covers 3 years from September 2016 to August 2019. An analysis of prospectively collected data was performed. Performance of the individual surgeons and collective was collated and retrospectively analysed. Results The unit’s caseload for the 3 years period was 1224 procedures. Each surgeon’s share was similar, i.e. 454, 430 and 340 cases respectively (BCG 75 per annum). Most procedures were performed electively, some on emergency basis or within two weeks. Biliary duct stones were the most common indications for the procedure, followed by malignancy. Overall bile duct cannulation rate was 95.3%; and 91.8% for first ERCP (BSG > 85%). CBD clearance was achieved in 80.6% cases, and stone clearance at first ERCP was 78.6% (BSG > 75%). Successful stenting of extra-hepatic biliary stricture was achieved in 89.4% cases at first ERCP (BSG > 80%). Overall complications rate was 6.2% and for level 1 & 2 cases 5.3% (BSG less than 6% is accepted standard). Conclusions We performed a high volume of safe and effective ERCPs with low risk of complications in line with national standards. ERCP has become an exclusive therapeutic tool in surgical management of gall stones disease and biliary malignancy.