The impact of gastroenterology fellowship involvement on the ERCP outcomes

Year 2023, , 833 - 838, 30.07.2023

Rasim Eren Cankurtaran , İbrahim Ethem Güven , Yavuz Çağır , Edanur Taskin Osman Ersoy

https://doi.org/10.32322/jhsm.1309464

Abstract

Aims: This study aimed whether the companionship of the gastroenterology fellowships to operators performing high-volume ERCP, would adversely affect the safety and success of the procedure.
Methods: This retrospective observational study included 964 patients with naïve papilla who underwent ERCP between February 2019 and May 2022. Procedures with fellowship involvement were compared with procedures performed only by the expert operator in terms of cannulation success, procedure time, cannulation time, unintended PD cannulation, difficult cannulation, cannulation techniques, and post-procedure adverse events.
Results: The two groups were similar in terms of procedure difficulty, successful cannulation in the first session, overall successful canulation, unintended PD cannulation, difficult cannulation rates, and cannulation techniques. The median procedure time was significantly higher in the fellowship involvement group compared to the other group (p=0.008). There was no difference between the two groups in terms of adverse events after the procedure (p>0.05). Procedure difficulty were found an independent risk factor of adverse events in the multivariate analysis (Odds ratio: 2.3; 95% Cl 1.4-3.6; p<0.001).
Conclusion: Our study showed that the involvement of gastroenterology fellowships in the ERCP procedure prolonged the procedure and cannulation time but did not decrease the technical success and did not increase adverse events.

Keywords

ERCP training, gastroenterology fellowship, post-ERCP complications, endoscopic retrograde cholangiopancreatography

Supporting Institution

none

Project Number

none

References

• Wani S, Han S, Simon V, et al. Setting minimum standards for training in EUS and ERCP: results from a prospective multicentre study evaluating learning curves and competence among advanced endoscopy trainees. Gastrointest Endosc. 2019;89(6):1160-1168.
• Johnson G, Webster G, Boskoski I, et al. Curriculum for ERCP and endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2021;53(10):1071-1087.
• Wani S, Keswani RN, Petersen B, et al. Training in EUS and ERCP: standardizing methods to assess competence. Gastrointest Endosc. 2018;87(6):1371-1382.
• Voiosu T, Boskoski I, Voiosu A, et al. Impact of fellowship involvement on the outcome of ERCP procedures: results of a prospective multicentre observational trial. Endoscopy. 2020;52(2):115-122.
• Ekkelankamp VE, Koch AD, Rauws EA, Borsboom GJ, de Man RA, Kuipers EJ. Competence development in ERCP: the learning curve of novice trainees. Endoscopy. 2014;46:949-55.
• Elta GH, Jorgensen J, Coyle WJ. Training in interventional endoscopy: current and future state. Gastroenterology. 2015;148(3):488-490.
• Voiosu T, Bălănescu P, Voiosu A, et al. Measuring trainee competence in performing endoscopic retrograde cholangiopancreatography: A systematic review of the literature. United European Gastroenterol J. 2019;7(2):239-249. doi:10.1177/2050640618817110
• Schutz SM, Abbott RM. Grading ERCPs by degree of difficulty: a new concept to produce more meaningful outcome data. Gastrointest Endosc. 2000;51(5):535-539.
• Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37(3):383-393.
• 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(7):657-683.
• Johnson G, Webster G, Boskoski I, et al. Curriculum for ERCP and endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2021;53(10):1071-1087.
• 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 (6): 1160-1168.
• Voiosu T, Voiosu A, Bengus A, Rimbaş M, Mateescu B. Trainee involvement increases pre-cut rates and delays access to the common bile duct without an increase in procedure-related adverse events: a brave new world of ERCP training? Romanian J Int Med. 2018;56(1):55-61.
• 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. 2015;81(1):143-149.
• Frost JW, Kurup A, Shetty S, Fisher N. Does the presence of a trainee compromise success of biliary cannulation at ERCP? Endosc Int Open. 2017;5:E559-562.
• Liao Z, Li ZS, Leung JW, et al. Success rate and complications of ERCP performed during hands-on training courses: a multicentre study in China. Gastrointest Endosc. 2009;69(2):230-237.
• 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(11):1116-1127.