Grading the complexity of endoscopic procedures: results of an ASGE working party

Cotton, Peter B.; Eisen, Glenn M.; Romagnuolo, Joseph; Vargo, John J.; Baron, Todd H.; Tarnasky, Paul R.; Schutz, Stephen M.; Jacobson, Brian C.; Bott, Chris; Petersen, Bret T.

doi:10.1016/j.gie.2010.12.036

Cited by 234 publications

(172 citation statements)

References 11 publications

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“…The difficulty scale recommended by Cotton et al (9) seems to be convenient; however, it has not been confirmed clinically. In this study, we aimed to evaluate the effectiveness of the system in terms of predicting the success and complications of the procedure.…”

Section: Discussionmentioning

confidence: 92%

“…However, the effect on the results of the technical difficulty of the procedure is also indisputable. A working party of the American Society for Gastrointestinal Endoscopy (ASGE) recently published a grading system for the complexity of endoscopic procedures to provide rankings for the complexity of all major endoscopic procedures, including ERCP (9). This scale, which is expected to provide information to patients about the difficulty of the planned procedure, the expected technical success, in addition to providing information to endoscopists regarding which patients should undergo the procedure and which patients should be referred, was created via a voting procedure by endoscopists who are highly experienced in their fields.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the endoscopic retrograde cholangiopancreatography grading system: A prospective study from a tertiary care center

Torun

Parlak²,

Yıldız³

et al. 2016

Turk J Gastroenterol

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INTRODUCTIONEndoscopic retrograde cholangiopancreatography (ERCP) is a comparatively complicated endoscopic procedure that has been performed for more than 40 years (1). It requires specific equipment and a long learning period and causes a higher rate of and more severe complications than other standard endoscopic techniques. The risk of serious complications is perhaps the procedure's most important feature, and ERCP has been the subject of many studies concerned with complications (2,3).The technical success rate and the complication rate vary greatly in studies related to ERCP. The success rates vary between 76% and 95%, and severe complication rates range between 1% and 16% (4-6). Such degrees of variation in rates are far from acceptable. Although the reason for this variation originates in the differences in the definition of success and complication, the level of difficulty in these patients could also affect the success and complication rates.Skill and experience have a major effect on ERCP results (7,8). However, the effect on the results of the technical difficulty of the procedure is also indisputable. A working party of the American Society for Gastrointestinal Endoscopy (ASGE) recently published a grading system for the complexity of endoscopic procedures to provide rankings for the complexity of all major endoscopic procedures, including ERCP (9). This scale, which is expected to provide information to patients about the difficulty of the planned procedure, the expected technical success, in addition to providing information . When the difficulty of the procedures increased from 1 to 4, the adverse event rates increased from 1.3% to 10.4%. Conclusion: The findings support the evidence that the difficulty degrees of ERCP procedures can help predict the success and complication rates of the procedure. Because of the increased rates of failure and complications in more difficult cases, the procedures should be performed by experienced endoscopists in advanced centers.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Assessment of the endoscopic retrograde cholangiopancreatography grading system: A prospective study from a tertiary care center

Torun

Parlak²,

Yıldız³

et al. 2016

Turk J Gastroenterol

View full text Add to dashboard Cite

show abstract

“…Usually intra-procedure in gastric lesions, occurring in 3.4% to 7.2% and delayed in duodenum, reported in 3.1%-22% of patients [2,26]. In colorectal polypectomy, bleeding occurs in 0.3% to 6.1% [27].…”

Section: Polypectomymentioning

confidence: 99%

“…However, for several reasons some patients experience complications or, as correctly mentioned, adverse events (AEs) [1]. Even though there is substantial literature describing series of AEs, well-designed prospective trials and a standardized nomenclature with agreed-on definitions are lacking [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…AEs are distinct from incidents, also unplanned events, but that do not interfere with completion of the procedure; an example of this includes bleeding that stops spontaneously or with endoscopic therapy during the procedure. Concerning the timing, AEs can occur pre-, intra-(from entering the preparation area through leaving the endoscopy room), post-(up to 14 days), and late-procedure (any time after 14 days, usually up to 30 days) [1,2].…”

Section: Introductionmentioning

confidence: 99%

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Emergencies after endoscopic procedures

Rolanda

Caetano

Dinis-Ribeiro

2013

Best Practice & Research Clinical Gastroenterology

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Keywords:GI endoscopy adverse events GI emergencies Bleeding Haemorrhage Perforation Infection Embolization Diagnosis and management of severe complications a b s t r a c t Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation.

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Effect of Disposable Elevator Cap Duodenoscopes on Persistent Microbial Contamination and Technical Performance of Endoscopic Retrograde Cholangiopancreatography

et al. 2023

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ImportanceInfection transmission following endoscopic retrograde cholangiopancreatography (ERCP) can occur due to persistent contamination of duodenoscopes despite high-level disinfection to completely eliminate microorganisms on the instrument.ObjectiveTo determine (1) contamination rates after high-level disinfection and (2) technical performance of duodenoscopes with disposable elevator caps compared with those with standard designs.Design, Setting, and ParticipantsIn this parallel-arm multicenter randomized clinical trial at 2 tertiary ERCP centers in Canada, all patients 18 years and older and undergoing ERCP for any indication were eligible.InterventionThe intervention was use of duodenoscopes with disposable elevator caps compared with duodenoscopes with a standard design.Main Outcomes and MeasuresCoprimary outcomes were persistent microbial contamination of the duodenoscope elevator or channel, defined as growth of at least 10 colony-forming units of any organism or any growth of gram-negative bacteria following high-level disinfection (superiority outcome), and technical success of ERCP according to a priori criteria (noninferiority outcome with an a priori noninferiority margin of 7%), assessed by blinded reviewers.ResultsFrom December 2019 to February 2022, 518 patients were enrolled (259 disposable elevator cap duodenoscopes, 259 standard duodenoscopes). Patients had a mean (SD) age of 60.7 (17.0) years and 258 (49.8%) were female. No significant differences were observed between study groups, including in ERCP difficulty. Persistent microbial contamination was detected in 11.2% (24 of 214) of standard duodenoscopes and 3.8% (8 of 208) of disposable elevator cap duodenoscopes (P = .004), corresponding to a relative risk of 0.34 (95% CI, 0.16-0.75) and number needed to treat of 13.6 (95% CI, 8.1-42.7) to avoid persistent contamination. Technical success using the disposable cap scope was noninferior to that of the standard scope (94.6% vs 90.7%, P = .13). There were no differences between study groups in adverse events and other secondary outcomes.Conclusions and RelevanceIn this randomized clinical trial, disposable elevator cap duodenoscopes exhibited reduced contamination following high-level disinfection compared with standard scope designs, without affecting the technical performance and safety of ERCP.Trial RegistrationClinicalTrials.gov Identifier: NCT04040504

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Grading the complexity of endoscopic procedures: results of an ASGE working party

Cited by 234 publications

References 11 publications

Assessment of the endoscopic retrograde cholangiopancreatography grading system: A prospective study from a tertiary care center

Assessment of the endoscopic retrograde cholangiopancreatography grading system: A prospective study from a tertiary care center

Emergencies after endoscopic procedures

Effect of Disposable Elevator Cap Duodenoscopes on Persistent Microbial Contamination and Technical Performance of Endoscopic Retrograde Cholangiopancreatography

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