Performance measures for ERCP and endoscopic ultrasound: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Abstract

The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). We recommend that endoscopy services across Europe adopt the following seven key and one minor performance measures for EUS and ERCP, for measurement and evaluation in daily practice at center and endoscopist level:

1 Adequate antibiotic prophylaxis before ERCP (key performance measure, at least 90 %); 2 Antibiotic prophylaxis before EUS-guided puncture of cystic lesions (key performance measure, at least 95 %); 3 Bile duct cannulation rate (key performance measure, at least 90 %); 4 Tissue sampling during EUS (key performance measure, at least 85 %); 5 Appropriate stent placement in patients with biliary obstruction below the hilum (key performance measure, at least 95 %); 6 Bile duct stone extraction (key performance measure, at least 90 %); 7 Post-ERCP pancreatitis (key performance measure, less than 10 %). 8 Adequate documentation of EUS landmarks (minor performance measure, at least 90 %).

This present list of quality performance measures for ERCP and EUS recommended by ESGE should not be considered to be exhaustive: it might be extended in future to address further clinical and scientific issues.

• References

• 1 Rutter M, Senore C, Bisschops R. et al. The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures. Endoscopy 2015; 48: 81-89
• 2 Kaminski M, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
• 3 Bisschops R, Areia M, Coron E. et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2016; 48: 843-864
• 4 Linstone HA, Turoff M. 2nd edition The Delphi method – Techniques and applications. 2002 https://web.njit.edu/~turoff/pubs/delphibook/delphibook.pdf
• 5 Guyatt GH, Oxman AD, Vist GE. et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-926
• 6 Bretthauer M, Aabakken L, Dekker E. et al. Requirements and standards facilitating quality improvement for reporting systems in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position statement. Endoscopy 2016; 48: 291-294
• 7 Do A, Weinberg J, Kakkar A. et al. Reliability of adenoma detection rate is based on procedural volume. Gastrointest Endosc 2013; 77: 376-380
• 8 Khashab MA, Chithadi KV. Acosta RD et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 2015; 81: 81-89
• 9 Bai Y, Gao F, Gao J. et al. Prophylactic antibiotics cannot prevent endoscopic retrograde cholangiopancreatography-induced cholangitis: a meta-analysis. Pancreas 2009; 38: 126-130
• 10 Brand M, Bizos D, O’Farrell PJ. Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography. Cochrane Database Syst Rev 2010; CD007345 doi:10.1002/14651858.CD007345.pub2
• 11 O’Toole D, Palazzo L, Arotçarena R. et al. Assessment of complications of EUS-guided fine-needle aspiration. Gastrointest Endosc 2001; 53: 470-474
• 12 Lee LS, Saltzman JR, Bounds BC. et al. EUS-guided fine needle aspiration of pancreatic cysts: a retrospective analysis of complications and their predictors. Clin Gastroenterol Hepatol 2005; 3: 231-236
• 13 Kwok K, Chang JC, Lim BS. et al. Sa1419 A pilot study on the use of prophylactic antibiotics for EUS-guided pancreatic cyst aspiration. Gastrointest Endosc 2015; 81: AB207 doi:10.1016/j.gie.2015.03.190
• 14 Guarner-Argente C, Shah P, Buchner A. et al. Use of antimicrobials for EUS-guided FNA of pancreatic cysts: a retrospective, comparative analysis. Gastrointest Endosc 2011; 74: 81-86
• 15 Rivera R, Ray A, Zacharia G. Endoscopic ultrasound-guided fine needle aspiration of pancreatic cysts with and without antibiotic prophylaxis. Am J Gastroenterol 2010; 105: S572-S509
• 16 Polkowski M, Jenssen C, Kaye P. et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline – March 2017. Endoscopy 2017; 49: 989-1006
• 17 Bailey A, Bourke M, Williams S. et al. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis. Endoscopy 2008; 40: 296-301
• 18 Coté GA, Ansstas M, Pawa R. et al. Difficult biliary cannulation: use of physician-controlled wire-guided cannulation over a pancreatic duct stent to reduce the rate of precut sphincterotomy (with video). Gastrointest Endosc 2010; 71: 275-279
• 19 Kawakami H, Maguchi H, Mukai T. et al. A multicenter, prospective, randomized study of selective bile duct cannulation performed by multiple endoscopists: the BIDMEN study. Gastrointest Endosc 2012; 75: 362-372
• 20 Kubota K, Sato T, Kato S. et al. Needle-knife precut papillotomy with a small incision over a pancreatic stent improves the success rate and reduces the complication rate in difficult biliary cannulations. J Hepatobiliary Pancreat Sci 2013; 20: 382-388
• 21 Lopes L, Dinis-Ribeiro M, Rolanda C. Safety and efficacy of precut needle-knife fistulotomy. Scand J Gastroenterol 2014; 49: 759-765
• 22 Miao L, Li Q-P, Zhu M-H. et al. Endoscopic transpancreatic septotomy as a precutting technique for difficult bile duct cannulation. World J Gastroenterol 2015; 21: 3978-3982
• 23 Nakai Y, Isayama H, Sasahira N. et al. Risk factors for post-ERCP pancreatitis in wire-guided cannulation for therapeutic biliary ERCP. Gastrointest Endosc 2015; 81: 119-126
• 24 Panteris V, Vezakis A, Filippou G. et al. Influence of juxtapapillary diverticula on the success or difficulty of cannulation and complication rate. Gastrointest Endosc 2008; 68: 903-910
• 25 Park CS, Park CH, Koh HR. et al. Needle-knife fistulotomy in patients with periampullary diverticula and difficult bile duct cannulation. J Gastroenterol Hepatol 2012; 27: 1480-1483
• 26 Parlak E, Suna N, Kuzu UB. et al. Diverticulum with papillae: does position of papilla affect technical success?. Surg Laparosc Endosc Percutan Tech 2015; 25: 395-398
• 27 Peng C, Nietert PJ, Cotton PB. et al. Predicting native papilla biliary cannulation success using a multinational endoscopic retrograde cholangiopancreatography (ERCP) quality network. BMC Gastroenterol 2013; 13: 147
• 28 Rajnakova A, Goh PM, Ngoi SS. et al. ERCP in patients with periampullary diverticulum. Hepatogastroenterology 2003; 50: 625-628
• 29 Fukatsu H, Kawamoto H, Kato H. et al. Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors. Surg Endosc 2008; 22: 717-723
• 30 Ramesh J, Kim H, Reddy K. et al. Impact of pancreatic stent caliber on post-endoscopic retrograde cholangiopancreatogram pancreatitis rates in patients with confirmed sphincter of Oddi dysfunction. J Gastroenterol Hepatol 2014; 29: 1563-1567
• 31 Sasahira N, Kawakami H, Isayama H. et al. Early use of double-guidewire technique to facilitate selective bile duct cannulation: the multicenter randomized controlled EDUCATION trial. Endoscopy 2015; 47: 421-429
• 32 Testoni PA, Giussani A, Vailati C. et al. Precut sphincterotomy, repeated cannulation and post-ERCP pancreatitis in patients with bile duct stone disease. Dig Liver Dis 2011; 43: 792-796
• 33 Tham TC, Kelly M. Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrograde cholangiopancreatography. Endoscopy 2004; 36: 1050-1053
• 34 Tsuchiya T, Itoi T, Maetani I. et al. Effectiveness of the J-tip guidewire for selective biliary cannulation compared to conventional guidewires (The JANGLE Study). Dig Dis Sci 2015; 60: 2502-2508
• 35 Vihervaara H, Grönroos JM. Feasibility of the novel 3-step protocol for biliary cannulation – a prospective analysis. Surg Laparosc Endosc Percutan Tech 2012; 22: 161-164
• 36 Zhang Q-S, Han B, Xu J-H. et al. Needle-knife papillotomy and fistulotomy improved the treatment outcome of patients with difficult biliary cannulation. Surg Endosc 2016; 30: 5506-5512
• 37 Geraci G, Modica G, Sciumè C. et al. Intradiverticular ampulla of Vater: personal experience at ERCP. Diagn Ther Endosc 2013; 2013: 1-4
• 38 Halttunen J, Kylänpää L. A prospective randomized study of thin versus regular-sized guide wire in wire-guided cannulation. Surg Endosc 2013; 27: 1662-1667
• 39 Halttunen J, Meisner S, Aabakken L. et al. Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs. Scand J Gastroenterol 2014; 49: 752-758
• 40 Holt BA, Hawes R, Hasan M. et al. Biliary drainage: role of EUS guidance. Gastrointest Endosc 2016; 83: 160-165
• 41 Huang L, Yu Q, Zhang Q. et al. Comparison between double-guidewire technique and transpancreatic sphincterotomy technique for difficult biliary cannulation. Dig Endosc 2015; 27: 381-387
• 42 Ito K, Horaguchi J, Fujita N. et al. Clinical usefulness of double-guidewire technique for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography. Dig Endosc 2014; 26: 442-449
• 43 Katsinelos P, Paroutoglou G, Kountouras J. et al. A comparative study of standard ERCP catheter and hydrophilic guide wire in the selective cannulation of the common bile duct. Endoscopy 2008; 40: 302-307
• 44 Testoni PA, Mariani A, Aabakken L. et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 657-683
• 45 Aithal GP, Anagnostopoulos GK, Tam W. et al. EUS-guided tissue sampling: comparison of “dual sampling” (Trucut biopsy plus FNA) with “sequential sampling” (Trucut biopsy and then FNA as required). Endoscopy 2007; 39: 725-730
• 46 Ardengh JC, Lopes CV, de Lima LFP. et al. Cell block technique and cytological smears for the differential diagnosis of pancreatic neoplasms after endosonography-guided fine-needle aspiration. Acta Gastroenterol Latinoam 2008; 38: 246-251
• 47 Iglesias-Garcia J, Dominguez-Munoz JE, Abdulkader I. et al. Influence of on-site cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses. Am J Gastroenterol 2011; 106: 1705-1710
• 48 Jhala NC, Jhala D, Eltoum I. et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy: a powerful tool to obtain samples from small lesions. Cancer 2004; 102: 239-246
• 49 Alatawi A, Beuvon F, Grabar S. et al. Comparison of 22G reverse-beveled versus standard needle for endoscopic ultrasound-guided sampling of solid pancreatic lesions. United Eur Gastroenterol J 2015; 3: 343-352
• 50 Baek HW, Park MJ, Rhee Y-Y. et al. Diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology of pancreatic lesions. J Pathol Transl Med 2015; 49: 52-60
• 51 Carrara S, Anderloni A, Jovani M. et al. A prospective randomized study comparing 25-G and 22-G needles of a new platform for endoscopic ultrasound-guided fine needle aspiration of solid masses. Dig Liver Dis 2016; 48: 49-54
• 52 Cleveland P, Gill KRS, Coe SG. et al. An evaluation of risk factors for inadequate cytology in EUS-guided FNA of pancreatic tumors and lymph nodes. Gastrointest Endosc 2010; 71: 1194-1199
• 53 Eloubeidi MA, Jhala D, Chhieng DC. et al. Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma. Cancer 2003; 99: 285-292
• 54 Fritscher-Ravens A, Sriram PVJ, Krause C. et al. Detection of pancreatic metastases by EUS-guided fine-needle aspiration. Gastrointest Endosc 2001; 53: 65-70
• 55 Fritscher-Ravens A, Sriram PVJ, Bobrowski C. et al. Mediastinal lymphadenopathy in patients with or without previous malignancy: EUS-FNA-based differential cytodiagnosis in 153 patients. Am J Gastroenterol 2000; 95: 2278-2284
• 56 Hucl T, Wee E, Anuradha S. et al. Feasibility and efficiency of a new 22G core needle: a prospective comparison study. Endoscopy 2013; 45: 792-798
• 57 Iglesias-Garcia J, Dominguez-Munoz JE, Abdulkader I. et al. Influence of on-site cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses. Am J Gastroenterol 2011; 106: 1705-1710
• 58 Wani S, Wallace MB, Cohen J. et al. Quality indicators for EUS. Gastrointest Endosc 2015; 81: 67-80
• 59 Miao L, Fan Z, Ji G. et al. Endoscopic stent for palliating malignant and benign biliary obstruction. Chinese J Cancer Res 2004; 16: 118-122
• 60 van Berkel A-M, Huibregtse IL, Bergman JJ. et al. A prospective randomized trial of Tannenbaum-type Teflon-coated stents versus polyethylene stents for distal malignant biliary obstruction. Eur J Gastroenterol Hepatol 2004; 16: 213-217
• 61 Kuo C-M, Chiu Y-C, Changchien C-S. et al. Endoscopic papillary balloon dilation for removal of bile duct stones: evaluation of outcomes and complications in 298 patients. J Clin Gastroenterol 2012; 46: 860-864
• 62 Oppong KW, Romagnuolo J, Cotton PB. The ERCP quality network benchmarking project: A preliminary comparison of practice in UK and USA. Front Gastroenterol 2012; 3: 157-161
• 63 Cotton PB, Lehman G, Vennes J. et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37: 383-393
• 64 Kochar B, Akshintala VS, Afghani E. et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc 2014; 81: 143-149.e9
• 65 Kapral C, Duller C, Wewalka F. et al. Case volume and outcome of endoscopic retrograde cholangiopancreatography: results of a nationwide Austrian benchmarking project. Endoscopy 2008; 40: 625-630
• 66 Testoni PA, Mariani A, Giussani A. et al. Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study. Am J Gastroenterol 2010; 105: 1753-1761
• 67 Enochsson L, Swahn F, Arnelo U. et al. Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP. Gastrointest Endosc 2010; 72: 1175-1184
• 68 Glomsaker T, Hoff G, Kvaløy JT. et al. Patterns and predictive factors of complications after endoscopic retrograde cholangiopancreatography. Br J Surg 2013; 100: 373-380
• 69 Dumonceau J-M, Andriulli A, Elmunzer BJ. et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – updated June 2014. Endoscopy 2014; 46: 799-815