Rajesh N Keswani1, Bashar J Qumseya2, Linda C O'Dwyer3, Sachin Wani4. 1. Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: raj-keswani@northwestern.edu. 2. Division of Gastroenterology and Hepatology, Archbold Medical Group, Florida State University, Thomasville, Georgia. 3. Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 4. Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Abstract
BACKGROUND & AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) has become a predominantly therapeutic intervention with a resultant increase in complexity. The relationship between ERCP volume and outcomes is unclear. We aimed to conduct a systematic review and meta-analysis assessing the relationship between endoscopist and center ERCP volume with ERCP success and adverse event (AE) rates. METHODS: A comprehensive search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted from inception to January 2017. Studies providing outcomes stratified by endoscopist and/or center volume were included in the final analysis. Endoscopist/center volume was stratified as low volume (LV) and high volume (HV). The definition of ERCP success varied between studies. The overall AE rate was a composite rate including pancreatitis, perforation, and bleeding. RESULTS: A literature search resulted in 1264 citations. Of those, 13 articles (n = 59,437 ERCPs) met inclusion criteria. LV endoscopist (<25 to <156 annual ERCPs) and center (<87 to <200 annual ERCPs) definitions varied between studies. HV endoscopists were significantly more likely to achieve ERCP success compared with LV endoscopists (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2-2.1). HV centers were significantly more likely to achieve ERCP success (OR, 2; 95% CI, 1.6-2.5). The post-ERCP AE risk was lower for HV endoscopists (OR, 0.7; 95% CI, 0.5-0.8) but not HV centers (OR, 0.7; 95% CI, 0.3-1.5). CONCLUSIONS: This study identifies a significant relationship between increasing endoscopist and center ERCP volume with overall procedure success. Increasing endoscopist volume also was associated with a decreased AE rate. Given these compelling findings, we propose that providers and payers consider consolidating ERCP to HV endoscopists to improve ERCP outcomes and value.
BACKGROUND & AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) has become a predominantly therapeutic intervention with a resultant increase in complexity. The relationship between ERCP volume and outcomes is unclear. We aimed to conduct a systematic review and meta-analysis assessing the relationship between endoscopist and center ERCP volume with ERCP success and adverse event (AE) rates. METHODS: A comprehensive search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted from inception to January 2017. Studies providing outcomes stratified by endoscopist and/or center volume were included in the final analysis. Endoscopist/center volume was stratified as low volume (LV) and high volume (HV). The definition of ERCP success varied between studies. The overall AE rate was a composite rate including pancreatitis, perforation, and bleeding. RESULTS: A literature search resulted in 1264 citations. Of those, 13 articles (n = 59,437 ERCPs) met inclusion criteria. LV endoscopist (<25 to <156 annual ERCPs) and center (<87 to <200 annual ERCPs) definitions varied between studies. HV endoscopists were significantly more likely to achieve ERCP success compared with LV endoscopists (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2-2.1). HV centers were significantly more likely to achieve ERCP success (OR, 2; 95% CI, 1.6-2.5). The post-ERCP AE risk was lower for HV endoscopists (OR, 0.7; 95% CI, 0.5-0.8) but not HV centers (OR, 0.7; 95% CI, 0.3-1.5). CONCLUSIONS: This study identifies a significant relationship between increasing endoscopist and center ERCP volume with overall procedure success. Increasing endoscopist volume also was associated with a decreased AE rate. Given these compelling findings, we propose that providers and payers consider consolidating ERCP to HV endoscopists to improve ERCP outcomes and value.
Authors: Caitlin B Finn; Jason K Tong; Hannah E Alexander; Chris Wirtalla; Heather Wachtel; Carmen E Guerra; Shivan J Mehta; Richard Wender; Rachel R Kelz Journal: J Gen Intern Med Date: 2022-04-19 Impact factor: 6.473
Authors: Nauzer Forbes; Millie Chau; Hannah F Koury; B Cord Lethebe; Zachary L Smith; Sachin Wani; Rajesh N Keswani; B Joseph Elmunzer; John T Anderson; Steven J Heitman; Robert J Hilsden Journal: Gastrointest Endosc Date: 2020-12-30 Impact factor: 9.427
Authors: B Joseph Elmunzer; Catharine M Walsh; Gretchen Guiton; Jose Serrano; Amitabh Chak; Steven Edmundowicz; Richard S Kwon; Daniel Mullady; Georgios I Papachristou; Grace Elta; Todd H Baron; Patrick Yachimski; Evan L Fogel; Peter V Draganov; Jason R Taylor; James Scheiman; Vikesh K Singh; Shyam Varadarajulu; Field F Willingham; Gregory A Cote; Peter B Cotton; Violette Simon; Rebecca Spitzer; Rajesh Keswani; Sachin Wani Journal: Gastrointest Endosc Date: 2020-07-30 Impact factor: 9.427