Impact of Hospital Volume and the Experience of Endoscopist on Adverse Events Related to Endoscopic Retrograde Cholangiopancreatography: A Prospective Observational Study = Impact of Hospital Volume and the Experience of Endoscopist on Adverse Events Related to Endoscopic Retrograde Cholangiopancreatography: A Prospective Observational Study

다국어 초록 (Multilingual Abstract)

Background/Aims: Few studies have addressed the relationship between the occurrence of adverse events (AEs) in endoscopic retrograde cholangiopancreatography (ERCP) and hospital case volume or endoscopist’s experience with inconsistent results. The aim of our study was to investigate the impact of hospital case volume and endoscopist’s experience on the AEs associated with ERCP and to analyze patient- and procedure-related risk factors for post-ERCP AEs. Methods: From January 2015 to December 2015, we prospectively enrolled patients with naïve papilla who underwent ERCP at six centers. Patient- and procedure-related variables were recorded on data collection sheets at the time of and after ERCP. Results: A total of 1,191 patients (median age, 71 years) were consecutively enrolled. The overall success rate of biliary cannulation was 96.6%. Overall, 244 patients (20.5%) experienced post-ERCP AEs, including pancreatitis (9.0%), bleeding (11.8%), perforation (0.4%), cholangitis (1.2%), and others (0.9%). While post-ERCP pancreatitis (PEP) was more common when the procedure was performed by less experienced endoscopists, bleeding was more common in high-volume centers and by less experienced endoscopists. Multivariate analysis showed that a less experience in ERCP was significantly associated with PEP (odds ratio [OR], 1.630; 95% confidence interval [CI], 1.050 to 2.531; p=0.030) and post-ERCP bleeding (OR, 1.439; 95% CI, 1.003 to 2.062; p=0.048). Conclusions: Our study demonstrated that overall AEs following ERCP were associated with the experience of the endoscopist. To minimize post-ERCP AEs, rigorous training with a sufficient case volume is required, and treatment strategies should be modified according to the endoscopist’s expertise.

참고문헌 (Reference)

1 Testoni PA, "Risk factors for post-ERCP pancreatitis in high-and low-volume centers and among expert and non-expert operators : a prospective multicenter study" 105 : 1753-1761, 2010

2 Freeman ML, "Risk factors for post-ERCP pancreatitis : a prospective, multicenter study" 54 : 425-434, 2001

3 Cheng CL, "Risk factors for post-ERCP pancreatitis : a prospective multicenter study" 101 : 139-147, 2006

4 Masci E, "Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography : a meta-analysis" 35 : 830-834, 2003

5 Vandervoort J, "Risk factors for complications after performance of ERCP" 56 : 652-656, 2002

6 Cotton PB, "Risk factors for complications after ERCP : a multivariate analysis of 11, 497 procedures over 12 years" 70 : 80-88, 2009

7 Williams EJ, "Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study" 39 : 793-801, 2007

8 Wang P, "Risk factors for ERCP-related complications : a prospective multicenter study" 104 : 31-40, 2009

9 Kawaguchi Y, "Randomized controlled trial of pancreatic stenting to prevent pancreatitis after endoscopic retrograde cholangiopancreatography" 18 : 1635-1641, 2012

10 Kapral C, "Quality assessment of endoscopic retrograde cholangiopancreatography : results of a running nationwide Austrian benchmarking project after 5 years of implementation" 24 : 1447-1454, 2012

11 Masci E, "Prospective multicenter quality assessment of endotherapy of biliary stones : does center volume matter" 39 : 1076-1081, 2007

12 ASGE Training Committee, "Principles of training in GI endoscopy" 75 : 231-235, 2012

13 Glomsaker T, "Patterns and predictive factors of complications after endoscopic retrograde cholangiopancreatography" 100 : 373-380, 2013

14 Enochsson L, "Nationwide, population-based data from 11, 074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP" 72 : 1175-1184, 2010

15 Stapfer M, "Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy" 232 : 191-198, 2000

16 Udd M, "Management of difficult bile duct cannulation in ERCP" 2 : 97-103, 2010

17 Loperfido S, "Major early complications from diagnostic and therapeutic ERCP : a prospective multicenter study" 48 : 1-10, 1998

18 Kochar B, "Incidence, severity, and mortality of post-ERCP pancreatitis : a systematic review by using randomized, controlled trials" 81 : 143-149, 2015

19 Andriulli A, "Incidence rates of post-ERCP complications : a systematic survey of prospective studies" 102 : 1781-1788, 2007

20 Vitte RL, "Evaluation of endoscopic retrograde cholangiopancreatography procedures performed in general hospitals in France" 31 : 740-749, 2007

21 Classen M, "Endoscopic sphincterotomy of the papilla of Vater and extraction of stones from the choledochal duct(author’s transl)" 99 : 496-497, 1974

22 Kawai K, "Endoscopic sphincterotomy of the ampulla of Vater" 20 : 148-151, 1974

23 Rustagi T, "Endoscopic retrograde cholangiopancreatography-related adverse events : general overview" 25 : 97-106, 2015

24 Galeazzi M, "Endoscopic retrograde cholangiopancreatography in the elderly : results of a retrospective study and a geriatricians’ point of view" 18 : 38-, 2018

25 문희석, "Education and Training Guidelines for the Board of the Korean Society of Gastrointestinal Endoscopy" 대한소화기내시경학회 50 (50): 345-356, 2017

26 Siiki A, "ERCP procedures in a Finnish community hospital : a retrospective analysis of 1207 cases" 101 : 45-50, 2012

27 Petersen BT, "ERCP outcomes : defining the operators, experience, and environments" 55 : 953-958, 2002

28 Freeman ML, "Complications of endoscopic retrograde cholangiopancreatography : avoidance and management" 22 : 567-586, 2012

29 Freeman ML, "Complications of endoscopic biliary sphincterotomy" 335 : 909-918, 1996

30 Mergener K, "Complications of endoscopic and radiologic investigation of biliary tract disorders" 13 : 173-181, 2011

31 Masci E, "Complications of diagnostic and therapeutic ERCP : a prospective multicenter study" 96 : 417-423, 2001

32 Kapral C, "Case volume and outcome of endoscopic retrograde cholangiopancreatography : results of a nationwide Austrian benchmarking project" 40 : 625-630, 2008

33 Keswani RN, "Association between endoscopist and center endoscopic retrograde cholangiopancreatography volume with procedure success and adverse outcomes : a systematic review and meta-analysis" 15 : 1866-1875, 2017