A modern approach to ERCP: maintaining efficacy while optimising safety

Abstract

Background and Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging and complications such as post-ERCP pancreatitis (PEP) remain a concern. Modern ERCP techniques aim to maintain efficacy and improve safety. There are limited data regarding efficacy and safety of ERCP carried out by a newly qualified practitioner using modern techniques. The aim of the present study was to conduct an ERCP practice audit and compare it with an Australian national survey in order to review the evidence base underlying modern ERCP practice.Methods: All ERCP carried out by a newly qualified practitioner, using prospectively collected data, from September 2011 to May 2015, were audited. Outcomes were compared to an Australiawide survey of ERCP practice. A literature review was carried out regarding recent developments in ERCP practice.Results: Audit results correlated well with national data. All 478 ERCP were therapeutic and had pre-procedure imaging. Wireguided biliary cannulation was used. Success rate was 97%. Overall adverse-event rate was 0.8%. Choledocholithiasis was the predominant indication (72%). Biliary cannulation was successful in 338 of 348 naiive papillae. Of these, there were 53 (16%) difficult cannulations but the needle-knife sphincterotomy (NKS) rate was low compared to national data (13% vs 33%). Rate of dual-wire cannulation technique was higher (87% vs 30%). Pancreatic duct stenting (done in 32 cases [70% of dual-wire cannulation cases]) and rectal indomethacin (25%) were used to reduce PEP risk.Conclusions: A newly qualified ERCP proceduralist achieved high success rates with minimal adverse events using modern techniques. Practice was consistent with national data, although dualwire cannulation technique was preferred to NKS. Evidence base for modern ERCP techniques was reviewed. ERCP efficacy and safety should be monitored by practice audit.

A Clinical Audit of Endoscopic Retrograde Cholangiopancreaticogram of Patients performed in a Secondary Care Hospital

“…The adverse-event rate among these procedures was 0.8% overall and the major indication for procedure was choledocholithiasis (72%). 17 In our study success rate was similar to a bit higher rate of 4.5% complication probably due to the advance stage of disease and patients presenting in at advanced disease state. 11 12,17 However, those patients who were unable to give consent due to the severity of their illness excluded their ERCP findings from the audit.…”

Adenomyoma of the distal common bile duct demonstrated by endoscopic ultrasound: A case report and review of the literature

“…Endoscopic retrograde cholangiopancreatography (ERCP), another imaging option, is considered the gold standard for the diagnosis of distal CBD abnormalities[15-17]. However, it may induce severe complications such as post-ERCP pancreatitis[18]. MRCP and EUS are less invasive and useful in diagnosing malignancy and choledocholithiasis in the dilated biliary tree[19,20].…”

ERCP practice beyond the training period – bridging the gap between guidelines and real-life practice: a single operator experience of 679 procedures

“…It is important to underscore the fact that procedure-related outcomes from our cohort, both in terms of technical success and procedure-related adverse events, compared favorably with suggested quality standards, with a cannulation rate consistently above 85% and low-complication rates, even when trainees were involved. Also, the limited data available from studies of endoscopic practice just after the training period suggests that precut rates for endoscopists starting independent practice is above 10%, without compromising technical success and patient safety [28,29].…”