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

Abstract

Background. Endoscopic retrograde cholangiopancreatography has evolved significantly in recent years. The increase in complexity and range of applications has not been adequately reflected in an improvement of training methods for ERCP, with many endoscopists failing to meet required performance standards during their training period and limited available data on their performance immediately after completing training. We aimed to analyze the performance of an independent operator from a developing country after the completion of formal training with regard to procedure and patient-related outcomes. Methods. We conducted an observational study of ERCPs performed by a young endoscopist from a referral center. Data about the procedure, cannulation technique (including use of precut), trainee involvement and procedure-related outcomes was retrieved and analyzed from a prospectively maintained database on quality in ERCP (the QUASIE initiative). Results. Data from 679 consecutive ERCPs conducted or supervised by one endoscopist with < 200 independent procedures prior to the study period were included in the final analysis. Cannulation rates significantly improved over time, from 90% to 96% (p = 0.016). Use of precut techniques changed significantly over time, with an initial increase followed by a subsequent decrease as overall cannulation rates improved. Trainee involvement was significantly associated with prolonged cannulation times (p = 0.003) and use of precut (p = 0.001), but did not impact on technical success or patient safety. Conclusions. Independent practice of ERCP after the training period is characterized by ongoing changes in technique, especially with regard to cannulation and use of precut, showing significant improvements in performance over time.

Seis meses de entrenamiento en Colangiografía Endoscópica Retrograda en centro formador de alto volumen ¿es suficiente? Experiencia inicial en un hospital de la Araucanía.

“…La prevalencia de complicaciones en esta serie fue del 4,6%, similar o inferior a los registros nacionales e internacionales [1][2][3][4][5][7][8][9][10][11][12][13]15,17 .…”

“…La pancreatitis post-CPRE fue la complicación más frecuente, registrándose en el 2,7% de los casos. Aunque es la complicación más común, se encuentra dentro de los rangos inferiores de las series publicadas [3][4][5][12][13]17 . El análisis específico de estos casos corresponde a dos pancreatitis graves, una moderada y una leve según la clasificación de Cotton et al 7 .…”

“…El análisis de estos resultados de las primeras 150 CPRE de un operador recién entrenado plantea la posibilidad de que existan otros factores además del número de procedimientos por institución y por profesional que influyan en los resultados finales de cada paciente. La literatura internacional enfatiza principalmente la cantidad de procedimientos realizados durante la formación [11][12][13] , así como el número anual de procedimientos por institución u operador [1][2][3] .…”

A portrait of Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound training programs in Europe: Current practices and opportunities for improvement

“…Of note, PD/experts took an average of 18 months to start performing ERCP/EUS independently. In this regard, Voiosu et al 25 . described the evolution of ERCP practice of an advanced endoscopist at the beginning of this independent practice.…”

“…In this regard, Voiosu et al. 25 described the evolution of ERCP practice of an advanced endoscopist at the beginning of this independent practice. It was interesting to confirm that, beyond the training period, it is expected that the learning curve keeps evolving as experience increases.…”