Prospective evaluation of ERCP performance in an Italian regional database study.

Catheterization / statistics & numerical data Cholangiopancreatography, Endoscopic Retrograde / adverse effects Choledocholithiasis / diagnostic imaging Databases, Factual Hemorrhage / epidemiology Humans Italy / epidemiology Jaundice / diagnostic imaging Logistic Models Pancreatitis / epidemiology Prospective Studies Quality Indicators, Health Care Surveys and Questionnaires

Complications ERCP Post-ERCP pancreatitis Quality indicators

Journal

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver

ISSN: 1878-3562

Titre abrégé: Dig Liver Dis

Pays: Netherlands

ID NLM: 100958385

Informations de publication

Date de publication:
07 2019

Historique:

received: 29 09 2018

revised: 21 12 2018

accepted: 25 12 2018

pubmed: 6 2 2019

medline: 27 2 2020

entrez: 6 2 2019

Statut: ppublish

Résumé

Prospective studies about endoscopic retrograde cholangio-pancreatography (ERCP) in a community setting are rare. To assess success and complication rates of routinely-performed ERCP in a regional setting, and the priority quality indicators for ERCP practice. 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. 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. The procedural questionnaire proved to be an important tool to assess and verify the quality of routinely-performed ERCP performance in a community setting.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.dld.2018.12.021 PMID: 30718203

pubmed: 30718203

pii: S1590-8658(19)30002-7

doi: 10.1016/j.dld.2018.12.021

pii:

doi:

Types de publication

Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

Pagination

978-984