Quality In Endoscopic Retrograde Cholangiopancreatography: Utility Of A Prospective Database To Monitor Adherence To Quality Indicators

Aims To evaluate the technical performance and adherence to quality indicators in ERCP practice in a tertiary referral center.

Methods ERCPs performed between October 2016 and July 2019 registered in a prospective database at a tertiary referral centre were analysed. From 1103 procedures initially evaluated, 57 were excluded for the following reasons: age<18 years; incomplete procedure (gastrointestinal stenosis, food stasis, pre-procedure cardiovascular instability); post-surgery altered anatomy; refusal of informed consent. Final study sample included 1046 procedures. The technical performance was compared with priority quality indicators recommended by the American Society of Gastrointestinal Endoscopy(ASGE) and the European Society of Gastrointestinal Endoscopy(ESGE).

Results Median age was 75.7(18 – 100) years with 546(51.2 %) patients being males. Indications for ERCP were: choledocholithiasis in 587(56.1 %) procedures, malignant biliary stenosis in 306(29.3 %), benign biliary stenosis in 64(6.1 %), biliary fistula in 42(4 %), acute gall stone pancreatitis in 26(2.5 %), pancreatic fistula in 6(0.6 %), ampullary neoplasm in 6(0.6 %), removal of bile duct stent in 5(0.5 %) and pancreatic stenosis in 4(0.4 %). Native papilla was present in 716(68.5 %) procedures. Native papilla successful cannulation rate was 91.3 %(639 procedures). The incidence of post-ERCP adverse events was: post-ERCP pancreatitis in 2.7 %(28 procedures), bleeding in 0.8 %(8 procedures), cholangitis in 0.7 %(7 procedures) and perforation in 0.5 %(5 procedures). The technical performance indicators of ERCPs compared to those recommended by ASGE and ESGE are presented in [table 1]. The following variables were performed in 100 % of procedures: clearance of common bile duct stones; stent placement in sub-hilar biliary strictures.

Table 1 Evaluation of ERCP technical performance measures compared to priority quality indicators recommended by ASGE and ESGE

	ASGE	ESGE	Technical performance
1. Appropriate indication for ERCP	> 90 %	N/A	100 %
2. Adequate antibiotic prophylaxis before ERCP	N/A	≥ 90 %	Not recorded
3. Native papilla bile duct cannulation rate	≥ 90 %	> 90 % (>95 % ideal)	91.3 %
4. Extraction rate of <1cm common bile ducts stones	≥ 90 %	> 90 %	100 %
5. Successful biliary stent placement rate	≥ 90 %	> 95 %	100 %
6. Post-ERCP pancreatitis rate	N/A	<10 % (<5 % ideal)	2.7 %

Conclusions The monitoring of adherence to quality indicators with a prospective database allows detailed analysis of performance indicators in ERCP. This may have contributed to the adequate patient selection, good technical outcomes and low incidence of adverse outcomes.

Citation de Sousa Damião F, Noronha Ferreira C, Moura M et al. eP126 QUALITY IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: UTILITY OF A PROSPECTIVE DATABASE TO MONITOR ADHERENCE TO QUALITY INDICATORS. Endoscopy 2021; 53: S137.

Publication History

Article published online:
19 March 2021