GRADING SUCCESS AND COMPLICATIONS IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP): THE AUSTRIAN SUCCESS AND COMPLICATION SCORE IN ERCP (ASCE – SCORE) A NOVEL GRADING SYSTEM

Aims:

The need for standardized benchmarks in endoscopic retrograde cholangiopancreatography (ERCP) has become a pressing matter in quality control and training supervision. The aim of this study was to evaluate and adapt the grading system for ERCP proposed by the American Society for Gastrointestinal Endoscopy (ASGE) 2011 by using a large-scale multicentre data set.

Methods:

Data of over 10.000 ERCPs was collected between 2013 and 2016 for the benchmarking project of the Austrian society of Gastroenterology and Hepatology (web-based questionnaire). Interventions were ranked as suggested by the ASGE. Complications and success of the procedures were recorded. Multiple regression was applied to the ASGE classification in respect to success and complications. Further each procedure suggested by ASGE was tested.

Results:

10917 ERCPS were documented in 28 different sites from primary to tertiary centres. ASGE grading of 1 – 4 were 14.5%; 51.3%; 28.0%; 6.2%. With overall success-/complication-rates of 83.1/6.8%; 89.3/10.9%; 86.2/8.5%; 73.4/11.5%. The multiple regression showed different results than predicted by the ASGE classification for most of the indications. Easy success did not necessarily stand for less complications. A score splitting success and complication with three levels of difficulty/risk was designed.

Tab. 1:

Selected indications graded by ASGE and ASCE-score

	ASGE classification (Cotton)	Regression success, < 1: lower chance of success	Regression complication, > 1: higher chance of risk	ASCE-score: success/complication
biliary stent removal/exchange	Grade 1	0.6	2.55	Grade 1/1 (high success/low risk)
place prophylactic pancreatic stents	Grade 2	0.7	2.38	Grade 3/3 (low success/high risk)
manage suspected sphincter Oddi dysfunction	Grade 3	7.3	9.3	Grade 1/3 (high success/high risk)
intraductal image guided therapy (eg. PDT; electrohydraulic lithotripsy)	Grade 4	1.6	not significant	Grade 1/2 (high success/intermediate risk)

Conclusions:

This data set cannot support the ASGEs classification. We could reveal that for grading ERCP success and complications have to be taken into account independently. The Austrian Success and Complication score in ERCP (ASCE – score) was created to incorporate these findings (table 1). With this score a potent tool for planning ERCP and training in endoscopy could be available.