Trainee caseload correlates with ERCP success rates but not with procedure-related complications: results from a prospective study (the QUASIE cohort)

Abstract

Background and study aim: Endoscopy society guidelines recommend a minimum of 200 cases for endoscopic retrograde cholangiopancreatography (ERCP) trainees in order to ensure competency and quality standards. However, there are few data regarding procedure-related complication rates and added risk for patients during this learning process. We aimed to evaluate the correlation between trainee caseload and procedure- and patient-related outcomes in an ERCP training program, and to assess the risk factors for ERCP failure and complications. Patients and methods: We conducted a prospective study of all procedures performed in the ERCP training program at Colentina Clinical Hospital, Bucharest, Romania. Relevant data for each procedure (diagnosis, cannulation method, outcome, and complications during the following 30 days) as well as operator experience were documented. Univariable and multivariable analysis of the risk factors for ERCP failure and complications was done by analyzing the procedures completed by expert and trainee endoscopists during the study period. Results: The analysis included 534 ERCPs performed by 1 expert and 3 supervised trainees during a 12-month period. Technical success rates were comparable in the trainee and expert groups, and no statistically significant difference was found between the two groups with regard to procedure-related complications and mortality. The more experienced trainees had a better chance of successfully completing a procedure (odds ratio of 1.1 for each additional 10 ERCPs performed), but post-ERCP complications were unrelated to individual trainee caseloads on multivariable analysis. Conclusion: The ERCP technical success rate increases with trainee experience, reflecting the learning curve of individual operators. However, the complication rates are similar across different levels of operator experience, indicating that ERCPs performed by supervised trainees imply no additional risk for patients.

Patient‐related factors associated with successful cannulation by trainees during hands‐on endoscopic retrograde cholangiopancreatography training

“…The incidence of overall complications and PEP in our study was 7.0% (73/1044) and 4.4% (46/1044), respectively, which seemed to be similar to previous reports . Our data support that involvement of trainees may not increase the risks of ERCP . Biliary infection in BS patients was found to be more frequent than that in CBDS patients (3.6% vs 0.7%, P = 0.004).…”

“…Previous ERCP caseload of trainees may affect the success of cannulation. 3 Here we did find that trainees achieved higher CSR in the latter half caseload compared with the first half ( Figure S2). Furthermore, as a result of a retrospective nature, details on performance of each trainee were lacking.…”

“…However, it did not reflect the final CSR at the end of training. Previous ERCP caseload of trainees may affect the success of cannulation . Here we did find that trainees achieved higher CSR in the latter half caseload compared with the first half (Figure S2).…”

“…21 Our data support that involvement of trainees may not increase the risks of ERCP. 3,22 Biliary infection in BS patients was found to be more frequent than that in CBDS patients (3.6% vs 0.7%, P = 0.004). This may be due to inadequate biliary drainage in BS patients.…”

“…Successful cannulation, one of the quality indicators of ERCP, 2 is most widely used as a competency marker. [3][4][5] Trainees should achieve adequate cannulation success rate (CSR) at the end of training. An accepted benchmark is set at a CSR of more than 80%.…”