부산대학교 도서관

This study analyzed how the annual volume of endoscopic retrograde cholangio-pancreatography (ERCP) influences outcomes in a hospital. Three periods were compared in which the number of endoscopists performing this technique was reduced and therefore more ERCP volume was allocated to each endoscopist. We analyzed the outcomes of 2 561 ERCPs in patients with intact papilla and found that the success rate was worse in the period with more endoscopists, while the rate of adverse events and post-ERCP pancreatitis was lower in the period with more endoscopists. The benefit of higher annual ERCP volume was not consistent across all endoscopists. In summary, this study indicates better ERCP outcomes when endoscopists perform a greater number of these techniques. Introduction: conflicting results have been reported regarding the influence of the annual volume of endoscopic retrograde cholangiopancreatography (ERCP) on outcome. Objective: to evaluate the influence of case volume on ERCP outcomes. Patients and methods: an analysis of a prospective database was performed, comparing the outcomes of ERCP in three consecutive periods defined by the number of endoscopists performing ERCP: five endoscopists in period I (P1), four in period II (P2) and three in period III (P3). Only patients with biliary ERCP in accessible and naive papilla were included. Primary variables were cannulation rates and adverse effects (AE). The American Society of Gastrointestinal Endoscopy (ASGE) complexity grades III and IV were considered as highly complex procedures. Results: a total of 2,561 patients were included: 727 (P1), 972 (P2) and 862 (P3). There were no differences in age and sex between groups (p > 0.05). The cannulation rate was significantly higher in P2 and P3: 92.4% vs 93.3% vs 93% (p = 0.037). The AE rate was 13.8%, 12.6% and 10.3% (p > 0.05), respectively. The rate of post-ERCP pancreatitis was significantly lower in P3: 8.5%, 7.3% and 5% (p = 0.01). The rate of complex procedures was 12%, 14.8% and 27% (p < 0.0001), respectively. Two endoscopists participated in all periods and only one had significantly improved outcomes. Cannulation and post-ERCP pancreatitis rates remained significantly better in P3 after adjusting for sex, complexity and endoscopist. Conclusion: a higher annual volume of ERCP per endoscopist was associated with a higher rate of cannulation and a lower rate of post-ERCP pancreatitis, despite the greater complexity of the procedures. These beneficial effects seem to differ between endoscopists. Keywords: Cholangiopancreatography. Endoscopic retrograde. Assessment. Outcomes. Activities. Training. Workload. Adverse effects. Biliary tract.
INTRODUCTION The endoscopic retrograde cholangiopancreatography (ERCP) is a complex therapeutic procedure. It would be expected that the skill of the endoscopist and training influence the outcome, as is the case [...]