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Endoscopy 2022; 54(03): 262-267
DOI: 10.1055/a-1499-7477
Original article

Implementation of mandatory ERCP registration in The Netherlands and compliance with European Society of Gastrointestinal Endoscopy performance measures: a multicenter database study

Felix Theunissen  ‡   *
1   Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
,
Sophia E. van der Wiel  ‡   *
1   Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
,
Pieter C. J. ter Borg
2   Department of Gastroenterology and Hepatology, Ikazia Ziekenhuis, Rotterdam, The Netherlands
,
Arjun D. Koch
1   Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
,
Rob J. T. Ouwendijk
3   Department of Gastroenterology and Hepatology, ADRZ, Goes, The Netherlands
,
Rob M. E. Slangen
4   Department of Gastroenterology and Hepatology, HagaZiekenhuis, The Hague, The Netherlands
,
Peter D. Siersema
5   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
,
Marco J. Bruno
1   Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
,
on behalf of the Trans.IT foundation study group› Author Affiliations
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ERCP: see one, do one, teach a few? Not everybody needs to learn everything!Endoscopy 2022; 54(03): 268-269
DOI: 10.1055/a-1642-0864

Abstract

Background In 2018, the European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) published quality performance measures for endoscopic retrograde cholangiopancreatography (ERCP). Since January 2016, all endoscopists in the Netherlands have been required to register all ERCP procedures in a nationwide quality registry. This study aimed to evaluate the procedural success rates of ERCP after the implementation of mandatory national registration and to compare these with the ESGE quality performance measures.

Methods This study was conducted with data from a multicenter endoscopy database. Data from 2019 and 2020 were analyzed. The primary outcome was ERCP procedural outcome. ESGE performance measures that could be evaluated were the percentage of successful bile duct cannulations in patients with virgin papillary anatomy; successful stent placement for a biliary obstruction located below the liver hilum; and complete removal of bile duct stones (< 10 mm).

Result In total, 5295 ERCPs performed in 11 centers were included for analysis. The overall procedural success rate was 89.1 %. Successful biliary cannulation in patients with a virgin papilla was 90.3 % in nonacademic and 92.4 % in academic centers. The rates of successful stent placement in patients with a biliary obstruction located below the liver hilum were 97.0 % in nonacademic and 98.2 % in academic centers, and of successful bile duct stone extraction were 97.9 % in both nonacademic and academic centers.

Conclusions The quality of ERCPs performed met five of the six evaluated ESGE performance measures. The 95 % target for successful biliary cannulation in patients with virgin papillary anatomy in academic centers was not met. Mandatory registration provides valuable insight into ERCP performance rates.

* Contributed equally to the manuscript




Publication History

Received: 15 January 2021

Accepted: 16 April 2021

Article published online:
09 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Carr-Locke DL. Overview of the role of ERCP in the management of diseases of the biliary tract and the pancreas. Gastrointest Endosc 2002; 56: S157-S160
    CrossrefPubMedSearch in Google Scholar
  • 2 Colton JB, Curran CC. Quality indicators, including complications, of ERCP in a community setting: a prospective study. Gastrointest Endosc 2009; 70: 457-467
    CrossrefPubMedSearch in Google Scholar
  • 3 Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc 2002; 56: S273-S282
    CrossrefPubMedSearch in Google Scholar
  • 4 Jowell PS, Baillie J, Branch MS. et al. Quantitative assessment of procedural competence. A prospective study of training in endoscopic retrograde cholangiopancreatography. Ann Intern Med 1996; 125: 983-989
    CrossrefPubMedSearch in Google Scholar
  • 5 Domagk D, Oppong KW, Aabakken L. et al. Performance measures for ERCP and endoscopic ultrasound: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2018; 50: 1116-1127
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Ekkelenkamp VE, Koch AD, Haringsma J. et al. Quality evaluation through self-assessment: a novel method to gain insight into ERCP performance. Frontline Gastroenterol 2014; 5: 10-16
    CrossrefPubMedSearch in Google Scholar
  • 7 Ekkelenkamp VE, de Man RA, Ter BorgF. et al. Prospective evaluation of ERCP performance: results of a nationwide quality registry. Endoscopy 2015; 47: 503-507
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Lantinga MA, Theunissen F, Ter Borg PCJ. et al. Impact of the COVID-19 pandemic on gastrointestinal endoscopy in the Netherlands: analysis of a prospective endoscopy database. Endoscopy 2021; 53: 166-170
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Schutz SM, Abbott RM. Grading ERCPs by degree of difficulty: a new concept to produce more meaningful outcome data. Gastrointest Endosc 2000; 51: 535-539
    CrossrefPubMedSearch in Google Scholar
  • 10 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Williams EJ, Ogollah R, Thomas P. et al. What predicts failed cannulation and therapy at ERCP? Results of a large-scale multicenter analysis. Endoscopy 2012; 44: 674-683
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 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
    CrossrefPubMedSearch in Google Scholar
  • 13 Glomsaker T, Hoff G, Kvaloy JT. et al. Patterns and predictive factors of complications after endoscopic retrograde cholangiopancreatography. Br J Surg 2013; 100: 373-380
    CrossrefPubMedSearch in Google Scholar
  • 14 Hallerback B, Enochsson L. A prospective nationwide study on the impact of the level of sedation on cannulation success and complications of endoscopic retrograde cholangiopancreatography. Ann Gastroenterol 2020; 33: 299-304
    PubMedSearch in Google Scholar
  • 15 Wani S, Han S, Simon V. et al. Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees. Gastrointest Endosc 2019; 89: 1160-1168
    CrossrefPubMedSearch in Google Scholar