Endoscopy 2019; 51(04): S73
DOI: 10.1055/s-0039-1681384
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: Education Club C
Georg Thieme Verlag KG Stuttgart · New York

IMPACT OF TRAINEE INVOLVEMENT ON TECHNICAL OUTCOME OF ERCP PROCEDURES AND PATIENT SAFETY: RESULTS OF A PROSPECTIVE MULTICENTER TRIAL

T Voiosu
1   Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
2   Internal Medicine, UMF Carol Davila School of Medicine, Bucharest, Romania
,
A Ladic
3   Department of Gastroenterology and Hepatology, UHC Zagreb, Zagreb, Croatia
,
A Bengus
1   Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
,
I Boskoski
4   Endoscopia Digestiva Chirurgica, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
,
B Busuioc
5   Endoscopy, Cantacuzino Clinical Hospital, Bucharest, Romania
,
I Klarin
6   Gastroenterology, Zadar General Hospital, Zadar, Croatia
,
A Voiosu
1   Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
,
V Bove
4   Endoscopia Digestiva Chirurgica, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
,
I Jovanovic
7   Gastroenterology and Hepatology, University of Belgrade Medical School, Belgrade, Serbia
,
M Rimbas
1   Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
8   Internal Medicine, Carol Davila Medical School, Bucharest, Romania
,
R Bogdan Mateescu
1   Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
8   Internal Medicine, Carol Davila Medical School, Bucharest, Romania
,
N Rustemovic
3   Department of Gastroenterology and Hepatology, UHC Zagreb, Zagreb, Croatia
,
G Costamagna
4   Endoscopia Digestiva Chirurgica, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
› Author Affiliations
Further Information

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.