Quality indicators for endoscopic retrograde cholangiopancreatography. The procedure of endoscopic retrograde cholangiopancreatography

Parras, Fernando Alberca de Las; López-Picazo, J.J.; Romero, Shirley Pérez; Río, A. Sánchez del; Júdez, Javier; Molina, Joaquín

doi:10.17235/reed.2018.5652/2018

Cited by 11 publications

(4 citation statements)

References 41 publications

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“…International standards and guidelines suggest a biliary cannulation rate ≥ 90 % 12 13 . The overall rates shown in our study are on par with these standards, and when divided between the two groups, cannulation rates remain above this benchmark.…”

Section: Discussionmentioning

confidence: 99%

Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study)

et al. 2022

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Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is traditionally performed with patients in the prone position (PP). However, this poses a potentially increased risk of anesthetic complications. An alternative is the left lateral (LL) decubitus position, which is commonly used for endoscopic procedures. Our aim was to compare cannulation rate, time, and outcomes in ERCP performed in LL versus PP. Patients and methods We conducted a non-inferiority, prospective, randomized control trial with 1:1 randomization to either LL or PP position. Patients > 18 years of age with native papillae requiring a therapeutic ERCP were recruited between March 2017 and November 2018 in a single tertiary center. Results A total of 253 patients were randomized; 132 to LL (52.2 %) and 121 to PP (47.8 %). Cannulation rates were 97.0 % in LL vs 99.2 % in PP (difference –2.2 % (one-sided 95 % CI: –5 % to 0.6 %). Median time to biliary cannulation was 03:50 minutes in LL vs 02:57 minutes in PP (P = 0.62). Pancreatitis rates were 2.3 % in LL vs 5.8 % in PP (P = 0.20). There were significantly lower radiation doses used in PP (0.23 mGy/m2 in LL vs 0.16 mGy/m2 in PP, P = 0.008) without a difference in fluoroscopy times. Conclusions Our analysis comparing LL to PP during ERCP shows comparable procedural and anesthetic outcomes, with significantly lower radiation exposure when performed in PP. We conclude that ERCP undertaken in the LL position is not inferior to PP, except for higher radiation exposure, and should be considered as a safe alternate position for patients undergoing ERCP.

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Section: Discussionmentioning

confidence: 99%

Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study)

et al. 2022

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“…The device was successfully used for procedures of all ASGE grades of complexity, with a low (6.7 %) incidence of crossover to a reusable duodenoscope and high (96 %) completion rate by both expert and less expert operators. Study practices met the published ERCP quality indicators 29 30 31 for most items that had study documentation. Consistent with the ESGE quality indicators for ERCP 30 , the rate of post-ERCP pancreatitis was < 10 % in our study.…”

Section: Discussionmentioning

confidence: 99%

Global prospective case series of ERCPs using a single-use duodenoscope

et al. 2023

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BACKGROUND & AIMS The first commercialized single-use duodenoscope was cleared by the US Food and Drug Administration in December 2019. Data regarding endoscopic retrograde cholangiopancreatography (ERCP) using a single-use duodenoscope are needed on a broader range of cases conducted by endoscopists with varying levels of experience in a wide range of geographic areas. METHODS Sixty-one endoscopists at 22 academic centers in 11 countries performed ERCP procedures in adult patients aged 18 and older. Outcomes included ERCP completion for the intended indication, rate of crossover to a reusable endoscope, device performance ratings, and serious adverse events (SAEs). RESULTS Among 551 patients, 236 (42.8%) were over age 65, 281 (51.0%) were male, and 256 (46.5%) had their procedure as an inpatient. ERCPs included 196 (35.6%) with American Society for Gastrointestinal Endoscopy grades 3-4 complexity. Five hundred and twenty-nine (96.0%) ERCPs were completed−503 (91.3%) using only the single-use duodenoscope, and 26 (4.7%) with crossover to a reusable endoscope. Twenty-two (4.0%) ERCPs were not completed, of which 11 (2.0%) included a crossover and 11 (2.0%) were aborted cases (no crossover). Median ERCP completion time was 24.0 minutes. Median overall satisfaction with the single-use duodenoscope was 8.0 (scale of 1 to 10 [best]). SAEs were reported in 43 (7.8%) patients, including 17 (3.1%) who developed post-ERCP pancreatitis. CONCLUSIONS In academic medical centers with wide geographic distribution, endoscopists with varying levels of experience using the first marketed single-use duodenoscope had good ERCP procedural success and reported high performance ratings for this device. (Clinicaltrials.gov, Number:04103749)

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“…During the meetings, the facility and equipment aspects of ERCP and the recently developed Korean guidelines for sedation and disinfection were excluded from the key questions. Based on ERCP QIs published in the United States and Europe, [4][5][6] the development committee selected key questions, considering their clinical importance and the healthcare environment in Korea, resulting in five key preprocedure, three intra-procedure, and four post-procedure questions (Table 1).…”

Section: Selection Of Key Questionsmentioning

confidence: 99%

Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea

Chon,

Kim,

Song

et al. 2024

Gut and Liver

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Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that requires significant experiences and skills and has various procedure-related complications, some of which can be severe and even result in the death of patients. Expanding ERCP availability has the advantage of increasing accessibility for patients. However, ERCP poses a substantial risk if performed without proper quality management. ERCP quality management is essential for both ensuring safe and successful procedures and meeting the social demands for enhanced healthcare competitiveness and quality assurance. To address these concerns, the Korean Pancreatobiliary Association established a task force to develop ERCP quality indicators (QIs) tailored to the Korean medical environment. Key questions for five pre-procedure, three intra-procedure, and four post-procedure measures were formulated based on a literature search related to ERCP QIs and a comprehensive clinical review conducted by experts. The statements and recommendations regarding each QI item were selected through peer review. The developed ERCP QIs were reviewed by external experts based on the latest available evidence at the time of development. These domestically tailored ERCP QIs are expected to contribute considerably to improving ERCP quality in Korea.

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Quality indicators for endoscopic retrograde cholangiopancreatography. The procedure of endoscopic retrograde cholangiopancreatography

Cited by 11 publications

References 41 publications

Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study)

Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study)

Global prospective case series of ERCPs using a single-use duodenoscope

Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea

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