Impact of trainee involvement on the outcome of ERCP procedures: results of a prospective multicenter observational trial

Abstract

Background Training in advanced endoscopic techniques such as endoscopic retrograde cholangiopancreatography (ERCP) should be driven by key performance measures and standardized competence assessment in order to provide safe and high-quality interventions. We aimed to determine whether the involvement of trainees influences the outcome of the procedure and the incidence of ERCP-related adverse events. Methods This was an international, multicenter, prospective, observational study conducted at six high- and low-volume centers across Europe between October 2016 and October 2018, and included independent operators and their trainees. Standard report forms documenting indication, trainee involvement, technical outcome, and complications over a 30-day follow-up of consecutive ERCP procedures were included in the analysis. Technical success of the procedure and procedure-related adverse events were compared between procedures in the trainee group and the control group using bivariable and multivariable analysis. Results 21 trainees and 16 control endoscopists performed 1843 ERCPs during the study period. Trainee involvement in ERCP procedures did not decrease technical success (92.4 % vs. 93.7 %; P = 0.30) or increase the risk of adverse events (14.7 % vs. 14.6 %; P > 0.99). Conversely, there were significantly more moderate or severe adverse events in the control group compared with the trainee group (6.2 % vs. 3.4 %, P = 0.01). On multivariable analysis, only increased bilirubin levels, time to cannulation, and procedure difficulty level increased the risk of any procedure-related adverse event. Conclusion Trainee involvement in ERCP interventions within a proper teaching setting is safe and does not compromise the success of the procedure.

Impact of mechanical simulator practice on clinical ERCP performance by novice surgical trainees: a randomized controlled trial

“…Furthermore, EMS practice does not pose any risks to patients. In a recent study involving 1843 ERCPs performed by 21 trainees and 16 control endoscopists [29], the success rate of the procedures was not compromised by the involvement of trainees.…”

“…ERCP procedures consist of multiple steps with diagnostic and therapeutic techniques and trainees do not necessarily learn the different steps in a systematic order. Cannulation is the most difficult and challenging step and papillotomy is considered to be the most dangerous part of an ERCP procedure [29]. The addition of EMS practice enables trainees to improve their learning experience.…”

Trainee involvement in ERCP: safe under close surveillance

“…In their study, Voiosu et al compared endoscopic retrograde cholangiopancreatographies (ERCPs) involving trainees with those performed exclusively by attending endoscopists [1]. No difference was detected in terms of technical success or adverse event rates.…”

Does trainee participation impact critical outcomes in ERCP?

“…In this issue of Endoscopy, Voiosu et al have addressed this critical knowledge gap in the field of ERCP training [4]. The primary aim of their prospective, multicenter, observational study was to compare the technical success and adverse event rates between ERCPs performed with or without the participation of trainees.…”