Subscribe to RSS
DOI: 10.1055/s-0039-1681384
IMPACT OF TRAINEE INVOLVEMENT ON TECHNICAL OUTCOME OF ERCP PROCEDURES AND PATIENT SAFETY: RESULTS OF A PROSPECTIVE MULTICENTER TRIAL
Publication History
Publication Date:
18 March 2019 (online)
Aims:
Quality standards for the practice of ERCP have been recently updated; however there is limited data regarding the impact of trainee involvement on procedure-related outcomes and patient safety. We aimed to evaluate whether trainee involvement increases the risk of procedure failure or adverse events.
Methods:
We conducted a prospective, multicenter observational study of ERCP procedures. Participating endoscopists completed a standard form after each procedure, providing clinical data, technical aspects of the procedure, including the degree of involvement of trainees, technical success and procedure-related adverse events. Trainees were defined as endoscopists who had performed < 200 ERCPs or were still working under supervision at the time of the study. Sample size was calculated to allow the detection with 90% power of a 5% increase in adverse event rates, from an estimated 10% in the control group to 15% in the trainee group.
Results:
Data from 1843 procedures performed by 18 independent operators and 22 endoscopists in training between October 2016 and October 2018 in 6 European centers were prospectively collected and analyzed. Common bile duct stones (46.8%) was the most frequent indication for ERCP. Trainees were involved in 822 (44.6%) procedures, including 543 native papilla cases, managing to complete their respective procedures without any assistance from their supervisor in 58.9% of the cases. The unassisted cannulation rate of a native papilla by trainees was 74.3%. Trainee involvement did not compromise cannulation rates (92.2% vs. 94.4%, p = 0.14), technical success rates (92.4% vs. 93.7%, p = 0.3) and did not increase the risk of procedure-related adverse events (14.8% vs. 13%, p = 0.3). On multivariate analysis, increased bilirubin levels and use of precut but not trainee involvement were identified as risk factors for procedure-related adverse events.
Conclusions:
Our study shows that trainee involvement in ERCP procedures does not compromise procedure outcome or patient safety.