Alberto Mariani1, Simone Segato2, Andrea Anderloni3, Gianpaolo Cengia4, Marco Parravicini5, Teresa Staiano6, Gian Eugenio Tontini7, Davide Lochis8, Paolo Cantù9, Guido Manfredi10, Arnaldo Amato11, Stefano Bargiggia12, Giordano Bernasconi13, Fausto Lella14, Marcella Berni Canani15, Paolo Beretta16, Luca Ferraris17, Sergio Signorelli18, Giuseppe Pantaleo19, Gianpiero Manes20, Pier Alberto Testoni2, Alberto Prada7, Elena Iiritano10, Enrico Lesinigo13, Gianni Santo Mezzi15, Germana de Nucci20. 1. Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: mariani.alberto@hsr.it. 2. Division of Gastroenterology and Gastrointestinal Endoscopy, Vita Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy. 3. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy. 4. Endoscopy Unit, Ospedale di Manerbio, Brescia, Italy. 5. Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliera Universitaria, Ospedale di Circolo di Varese, Varese, Italy. 6. Digestive Endoscopy and Gastroenterology Unit, Istituti Ospitalieri di Cremona, Cremona, Italy. 7. Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato, Italy. 8. Endoscopy Unit, Policlinico di Monza, Monza, Italy. 9. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 10. Gastroenterology and Digestive Endoscopy Department, Maggiore Hospital, ASST Crema, Crema, Italy. 11. Department of Gastroenterology Unit, Valduce Hospital, Como, Italy. 12. Division of Gastroenterology,"A. Manzoni" Hospital, Lecco, Italy. 13. Gastroenterology and Digestive Endoscopy Unit, Busto Arsizio Hospital, Busto Arsizio, Varese, Italy. 14. Gastroenterology and Digestive Endoscopy Unit, Policlinico San Pietro, Bergamo, Italy. 15. Digestive Endoscopy and Gastroenterology Unit, ASST Vimercate, Monza e Brianza, Italy. 16. Gastroenterology and Digestive Endoscopy Unit, ICCS, Milan, Italy. 17. Gastroenterologia ed Endoscopia Digestiva ASST Valleolona PO, Gallarate, Varese, Italy. 18. Gastroenterology and Gastrointestinal Endoscopy Unit, ASST, Papa Giovanni XXIII, Bergamo, Italy. 19. UniSR-Social.Lab [Research Methods], Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy. 20. Department of Gastroenterology and Digestive Endoscopy, ASST Rhodense Garbagnate Milanese, Milano, Italy.
Abstract
BACKGROUND: Prospective studies about endoscopic retrograde cholangio-pancreatography (ERCP) in a community setting are rare. AIM: To assess success and complication rates of routinely-performed ERCP in a regional setting, and the priority quality indicators for ERCP practice. METHODS: Prospective region wide observational study on consecutive patients undergoing ERCP during a 6-month period. A centralized online ERCP questionnaire was built and used for data storage. Primary quality indicators provided by the American Society of Gastrointestinal Endoscopy (ASGE) were considered. RESULTS: 38 endoscopists from 18 centers performed a total of 2388 ERCP. The most common indication for ERCP was choledocholitiasis (54.8%) followed by malignant jaundice (22.6%). Cannulation of the desired duct was obtained in 2293 cases (96%) and ERCP was successful in 2176 cases (91.1%). Success and ERCP difficulty were significantly related to the experience of the operator (p = 0.001 and p < 0.001, respectively). ERCP difficulty was also significantly related to volume centers (p < 0.01). The overall complication rate was 8.4%: post-ERCP pancreatitis (PEP) occurred in 4.1% of procedures, bleeding in 2.9%, infection in 0.8%, perforation in 0.4%. Mortality rate was 0.4%. All the ASGE priority quality indicators for ERCP were confirmed. CONCLUSIONS: The procedural questionnaire proved to be an important tool to assess and verify the quality of routinely-performed ERCP performance in a community setting.
BACKGROUND: Prospective studies about endoscopic retrograde cholangio-pancreatography (ERCP) in a community setting are rare. AIM: To assess success and complication rates of routinely-performed ERCP in a regional setting, and the priority quality indicators for ERCP practice. METHODS: Prospective region wide observational study on consecutive patients undergoing ERCP during a 6-month period. A centralized online ERCP questionnaire was built and used for data storage. Primary quality indicators provided by the American Society of Gastrointestinal Endoscopy (ASGE) were considered. RESULTS: 38 endoscopists from 18 centers performed a total of 2388 ERCP. The most common indication for ERCP was choledocholitiasis (54.8%) followed by malignant jaundice (22.6%). Cannulation of the desired duct was obtained in 2293 cases (96%) and ERCP was successful in 2176 cases (91.1%). Success and ERCP difficulty were significantly related to the experience of the operator (p = 0.001 and p < 0.001, respectively). ERCP difficulty was also significantly related to volume centers (p < 0.01). The overall complication rate was 8.4%: post-ERCP pancreatitis (PEP) occurred in 4.1% of procedures, bleeding in 2.9%, infection in 0.8%, perforation in 0.4%. Mortality rate was 0.4%. All the ASGE priority quality indicators for ERCP were confirmed. CONCLUSIONS: The procedural questionnaire proved to be an important tool to assess and verify the quality of routinely-performed ERCP performance in a community setting.
Authors: Nauzer Forbes; Hannah F Koury; Sydney Bass; Martin Cole; Rachid Mohamed; Christian Turbide; Emmanuel Gonzalez-Moreno; Ahmed Kayal; Millie Chau; B Cord Lethebe; Robert J Hilsden; Steven J Heitman Journal: J Can Assoc Gastroenterol Date: 2020-02-28