Z Gastroenterol 2018; 56(10): 1227-1236
DOI: 10.1055/a-0661-6068
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Österreichisches Benchmarking ERCP: 10-Jahresbericht

Austrian benchmarking project for ERCP: a 10-year report
Melanie Kienbauer
1   Interne 4 – Gastroenterologie, Ordensklinikum Linz Elisabethinen, Linz, Austria
,
Christine Duller
2   Johannes Kepler Universität Linz Institut für Angewandte Statistik, Linz, Austria
,
Michael Gschwantler
3   4. Medizinische Abteilung, Wilhelminenspital der Stadt Wien, Wien, Austria
,
Andreas Püspök
4   Abteilung für Innere Medizin II, Krankenhaus der Barmherzigen Brüder Eisenstadt, Eisenstadt, Austria
,
Rainer Schöfl
1   Interne 4 – Gastroenterologie, Ordensklinikum Linz Elisabethinen, Linz, Austria
,
Christine Kapral
1   Interne 4 – Gastroenterologie, Ordensklinikum Linz Elisabethinen, Linz, Austria
› Author Affiliations
Further Information

Publication History

07 April 2018

13 July 2018

Publication Date:
14 August 2018 (online)

Zusammenfassung

Seit 10 Jahren überblickt das Qualitätssicherungsprogramm „Benchmarking ERCP“ unter der Patronanz der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie (ÖGGH) mit einjähriger Unterbrechung (2008) in Zusammenarbeit mit dem Institut für Angewandte Statistik der Johannes Kepler Universität Linz die Ergebnisqualität, Erfolgsrate und Patientensicherheit bei der ERCP in Österreich anhand von derzeit 28 319 gesammelten Untersuchungen.

Die teilnehmenden Zentren mit unterschiedlicher ERCP-Frequenz und Untersucherzahl können so anhand des Vergleichs den gepoolten Benchmark-Daten individuelle Probleme in Hinblick auf Erfolgs-, Sondierungs- und Komplikationsraten (3,9 % Post-ERCP-Pankreatitiden, 3,8 % Blutungen, 0,6 % Perforationen, 1,2 % Cholangitiden, 1,0 % kardiopulmonale Komplikationen) erkennen und verbessern.

Abstract

The quality assurance program “Benchmarking ERCP”, that his been under the patronage of the ÖGGH for ten years (with a one-year break in 2008), in collaboration with the Institute for Applied Statistics University Linz, has followed patient safety measures and successes while undergoing ERCP in Austria. A total of 28 319 examinations were registered. The participating centers all had different ERCP frequency and variable expertise, thereby enabling them to recognise individual problems in terms of success, cannulation and complication rates (3.9 % post-ERCP pancreatitis, 3.8 % bleeding, 0.6 % perforation, 1.2 % cholangitis, 1.0 % cardiopulmonary complications). The aim of quality assurance measures in medicine is to ensure the best possible patient care.

 
  • Literatur

  • 1 McCune WS, Shorb PE, Moscovitz H. et al. Endoscopic cannulation of the ampulla of vater: a preliminary report. Ann Surg 1968; 167: 752-756
  • 2 Cotton PB, Garrow DA, Gallagher J. et al. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc 2009; 70: 80-88
  • 3 Wang P, Li ZS, Liu F. et al. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol 2009; 104: 31-40
  • 4 Andriuli A, Loperfido S, Napolitano G. et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007; 102: 1781-1788
  • 5 Freeman ML, Nelson DB, Sherman S. et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335: 909-918
  • 6 Loperfido S, Angelini G, Benedetti G. et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 1998; 48: 1-10
  • 7 Masci E, Toti A, Mariani S. et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001; 96: 417-423
  • 8 Vandervoort J, Soedikno RM, Tham TC. et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002; 56: 652-656
  • 9 Barthet M, Lesavre N, Desjeux A. et al. Complications of endoscopic sphincterotomy: results from a single tertiary referral center. Endoscopy 2002; 34: 991-997
  • 10 Martin L, Freeman ML. et al. Adverse outcomes of endoscopic retrograde cholangiopancreatography: avoidance and management. Gastrointest Endosc Clin N Am 2003; 13: 775-798
  • 11 Christensen M, Matzen P, Schulze S. et al. Complications of ERCP: a prospective study. Gastrointest Endosc 2004; 60: 721-731
  • 12 Freeman ML, Guda NM. et al. Prevention of post-ERCP pancreatitis: a comprehensive review. Gastrointest Endosc 2004; 59: 845-864
  • 13 Williams EJ, Taylor S, Fairclough P. et al. Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice. Gut 2007; 56: 821-829
  • 14 American Society for Gastrointestinal Endoscopy (ASGE). Guideline: Complications of ERCP. Gastroinest Endosc 2012; 75: 467-473
  • 15 Kapral C, Duller C, Wewalka F. et al. Case volume and outcome of endoscopic retrograde cholangiopancreaticography: results of a nationwide Austrian benchmarking project. Endoscopy 2008; 40: 625-630
  • 16 American Society of Gastrointestinal Endoscopy. Appropriate use of gastrointestinal endoscopy. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 2000; 52: 831-837
  • 17 O’Mahony S, Naylor G, Axon A. et al. Quality assurance in gastrointestinal endoscopy. Endoscopy 2000; 32: 483-488
  • 18 Johanson JF, Cooper G, Eisen GM. et al. Quality assessment of ERCP. Endoscopic retrograde cholangiopacreatography. Gastrointest Endosc 2002; 56: 165-169
  • 19 Naylor G, Gatta L, Butler A. et al. Setting up a quality assurance program in endoscopy. Endoscopy 2003; 35: 701-707
  • 20 Baron T, Petersen B, Mergener K. et al. Quality indicators for endoscopic retrograde cholangiopancreatography. Am J Gastroenterol 2006; 101: 892-897
  • 21 Faigel D, Pike I, Baron T. et al. Quality indicators for gastrointestinal endoscopic procedures: an introduction. Am J Gastroenterol 2006; 101: 866-872
  • 22 Weiss W. et al. Übersicht der Diagnose- und Therapiemöglichkeiten gastroenterologischer Einrichtungen in Spitälern und Ordinationen niedergelassener Fachärzte (Internisten, Chirurgen, gastroenterologische Spezialpraxen) in Österreich. ÖGGH (Hrsg). Endoskopie in Österreich 1. Ausgabe 2004/2005; Krause & Pachernegg GmbH Verlag für Medizin und Wirtschaft.
  • 23 Cotton PB, Eisen G, Romagnuolo J. et al. Grading the complexity of endoscopic procedures: results of an ASGE working party. Gastrointest Endosc 2011; 73: 868-874
  • 24 Ignatavicius P, Gulla A, Cernauskis K. et al. How severe is moderately severe acute pancreatitis? Clinical calidation of revised 2012 Atlanta Classification. World J Gastroenterol 2017; 23: 7785-7790
  • 25 Loperfido S, Monic F. Post-ERCP septic complications. UpToDate 2007. www.uptodate.com
  • 26 Dumonceau JM, Andriulli A, Deviere J. et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: Prophylaxis of post-ERCP pancreatitis – Update June 2014. Endoscopy 2014; 46: 799-815
  • 27 Kawguchi Y, Ogawa M, Omata F. et al. Randomized controlled trial of pancreatic stenting to prevent pancreatitis after endoscopic retrograde cholangiopancreaticography. World J Gastroenterol 2012; 18: 1635-1641
  • 28 Hou YC, Hu Q, Huang J. et al. Efficacy and safty of rectal nonsteroidal anti-inflammatory drugs for prophylaxis against post-ERCP pancreatitis: a systemic review and meta-analysis. Sci Rep 2017; 7: 46650
  • 29 Cotton PB, Lehman G, Vennes J. et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383-393
  • 30 Elmunzer BJ, Scheiman JM, Lehman GA. et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med 2012; 366: 1414-1422
  • 31 Cheng CL, Sherman S, Watkins JL. et al. Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol 2006; 101: 139-147
  • 32 Harris A, Chan AC, Torres-Viera C. et al. Meta-analysis of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy 1999; 31: 718-724
  • 33 Rey JR, Axon A, Budzynska A. et al. Guidelines of the European Society of Gastrointestinal Endoscopy (E.S.G.E.) antibiotic prophylaxis for gastrointestinal endoscopy. European Society of Gastrointestinal Endoscopy. Endoscopy 1998; 30: 318-324
  • 34 Hirota WK, Petersen K, Baron TH. et al. Standards of Practice Commitee of the American Society for Gastrointestinal Endoscopy: guidelines for antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 2003; 58: 475-482
  • 35 Banerjee S, Shen B, Baron TH. et al. American Society of Gastrointestinal. Endoscopy Guideline. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 2008; 67: 791-798
  • 36 Wewalka F, Kapral C, Brownstone E. et al. Antibiotic prophylaxis in gastrointestinal endoscopy-recommendations of the Austrian Society of Gastroenterology and Hepatology. Z Gastroenterol 2010; 48: 1225-1229
  • 37 Lella F, Bagnolo F, Colombo E. et al. A simple way of avoiding post-ERCP pancreatitis. Gastrointest Endosc 2004; 59: 830-834
  • 38 Bailey AA, Bourke MJ, Williams SJ. et al. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis. Endoscopy 2008; 40: 296-301
  • 39 Matsubara H, Urano F, Kinoshita Y. et al. Analysis of risk factors for severity in post endoscopic retrograde cholangiopanreatography pancreatitis: The indication of prophylactic treatments. World J Gastrointest Endosc 2017; 9: 189-195
  • 40 American Society for Gastrointestinal Endoscopy (ASGE). Guideline: Quality indicators for ERCP. Gastrointest Endosc 2015; 81: 1060