Safety and success of precut biliary sphincterotomy: Is it linked to experience or expertise

Abstract

AIM:To determine the rates of success and complications of precut biliary sphincterotomy (PBS) based on prior experience and to compare the complication rates between PBS and standard endoscopic sphincterotomy (ES). METHODS:A retrospective evaluation of prospectively collected non-randomized data at an academic tertiary referral center. The study included all patients in an eight-year period who underwent PBS and ES by a single endoscopist who had no formal training in PBS. The main outcome measures of the study were success and complications of PBS with a comparison to complications of ES. RESULTS:A total of 2939 endoscopic retrograde chola ngiopancreatographies (ERCPs) were performed during the study period, including 818 (28%) ES and 150 (5%) PBS procedures. Selective biliary cannulation via PBS was successful at the first attempt in 75% of the patients. Cannulation was achieved in an additional 13% of the patients at a subsequent attempt (total 87%). Complication rate from PBS was 45% higher than ES, but did not differ significantly [7% (10/50) vs 5% (38/818), P = 0.29]. None of the complications from PBS was severe. A significant trend towards increasing success existed with regard to the endoscopist's first attempt at precut (P = 0.0393, Cochran-Armitage exact test for trend, Z = -1.7588). CONCLUSION:Despite the lack of specific training in this technique, PBS was performed with a high success rate and a complication rate similar to or less than reports from other experienced centers. These results suggest that endoscopic experience and perhaps innate endoscopic skill may play an important role in the outcome of this procedure.

Untitled

“…There was a significant increase in the cannulation rate from an initial 60 % in the first 40 patients, to 85 % in the last group. Robinson et al reported a similar pattern with an increase from 68 % to 76 % when comparing the first 50 patients with the subsequent group of 25 [11,17]. Therefore, our results demonstrate that some degree of improvement exists in the cannulation success rate with NKF as procedural experience increases, although this effect might be greater for some operators and smaller or minimal for others.…”

“…Furthermore, as we cannot predict the innate skills of an endoscopist ab initium, a formal training period is recommended. The studies published often suggest 40 to 50 NKF as an adequate number of precuts for training, given that most endoscopists after this threshold report a needle-knife precut success above 70 % [5,11,14,16,17]. Although suggesting a minimum number of precuts for assessing proficiency in NKF is problematic, we propose 20 NKFs (and not 40 or 50) for the first moment of assessment.…”

“…The results from other studies are diverse, Harewood et al reported that the adverse events did not diminish over time and Fukatsu et al reported an increase from 10 % to 16 % (• " Table 3) [2,11,15,19]. On the other hand, Robinson et al reported a decrease in adverse events over time, which may be explained by the increased use of pancreatic stents in the latter groups (• " Table 3) [16,17,20,21]. One may argue that the nonexistence of a clear decline in the complication rates results from the use of precut only after a difficult biliary cannulation.…”

Saudi Enterprise and Critical Success Factors

“…In most cases, IT systems are standalone systems, without any ability of integration. In this way, different businesses processes are operating in silo which deters success of organization (Robison et al, 2007). One of the other factors which need to be taken into account in this respect is that the organizational actors have to ensure that they have the best systems put into place, which can enable the actors to develop and understand the issues of efficiency (Jun and Kim, 2010).…”

“…Another recommended way of use of IT is its ability to share important information and knowledge about customers choices (Robison et al, 2005). The way success is embedded in the use of IT system is that, newer ways of doing work will be initiated with the integration of IT system (Shutov, 2011) actors are able to implement the systems, and therefore the acceptance of new innovation is highly important for the organization (Chen and Chen, 2010).…”