KEY PERFORMANCE MEASURES FOR ERCP AMONG ADVANCE ENDOSCOPY INDIVIDUAL TRAINEE USING THE EUS AND ERCP SKILLS ASSESSMENT TOOL (TEESAT) IN TERTIARY REFERRAL CENTER IN BULGARIA

Aims To evaluate the percentage of reached key performance measures for Endoscopic retrograde cholangio-pancreatography (ERCP) during advance endoscopy training in young endoscopy postgraduate fellow.

Methods We conducted a prospective study from October 2018 until November 2019, enrolling 104 patients who were undergoing ERCP in a tertiary referral center University Hospital “Tsaritsa Yoanna – ISUL”, Sofia, Bulgaria with supervision of an expert and a trainee. We used validated, task-specific, skills-assessment “the EUS and ERCP skills assessment tool (TEESAT)” and grading for each skill was done using a 4-point scoring system and measuring the percentage of reached key performance measures for ERCP proposed by European Society of Gastrointestinal Endoscopy (ESGE) guidelines during fellow training.

Results Adequate antibiotic prophylaxis before ERPC was reached in 95% of the patients. Bile duct cannulation rate by the trainee was 75% and for the expert was 92% in cases of trainee failure. Mean time for bile duct cannulation was 11 minutes (6–15 min.). Clearance of common bile duct stones by the trainee was 91.4% of the cases. Stent placement below the hilum in cases of biliary obstruction was achieved in 84.6% of the cases. Post-ERCP pancreatitis (PEP) rate was 13.5% after trainee ERCP. Overall technical competence was achieved by the trainee for grade 1 ERCP in about 104 cases with TEESAT overall assessment 5 (average for level of training) evaluated by endoscopy expert. Competence for grade 2 ERCP was not achieved at this stage and 3 of the ESGE key performance measures was not reached.

Conclusions The thresholds of 104 ERCPs are not enough to reach all the ESGE key performance measures for ERCP. TEESAT is useful and easy to use assessment tool for evaluating competence during advance endoscopy training for ERCP and to improve quality of endoscopy we need to be implement TEESAT during endoscopy training to reach better learning curves.