A simple clinical score to stratify the risk of procedure-related adverse events in ERCP procedures with trainee involvement

Theodor A. Voiosu; Andreea Benguș; Michiel Bronswijk; Ivan Lyutakov; Ivo Klarin; Bianca Voiosu; Paul Bălănescu; Claudia Diaconu; Bogdan Busuioc; Ivo Boskoski; Andrei M. Voiosu; Radu B. Mateescu; Sachin Wani

doi:10.1055/a-2042-6288

Endoscopy, Inhaltsverzeichnis

Endoscopy 2023; 55(09): 804-811
DOI: 10.1055/a-2042-6288

Original article

A simple clinical score to stratify the risk of procedure-related adverse events in ERCP procedures with trainee involvement

Theodor A. Voiosu

¹Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania

²Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania

,

Andreea Benguș

¹Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania

,

Michiel Bronswijk

³Department of Gastroenterology and Hepatology, Imelda Hospital, Bonheiden, Belgium

⁴Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium

⁵Imelda GI Research Center, Bonheiden, Belgium

,

Ivan Lyutakov

⁶Department of Gastroenterology, University Hospital “Tsaritsa Yoanna – ISUL”, Sofia, Bulgaria

⁷Department of Gastroenterology, Medical University Sofia, Sofia, Bulgaria

,

Ivo Klarin

⁸Department of Health Studies, University of Zadar, Zadar, Croatia

⁹Gastroenterology Department, General Hospital Zadar, Zadar, Croatia

,

Bianca Voiosu

¹⁰Gastroenterology Department, Cantacuzino Hospital, Bucharest, Romania

,

Paul Bălănescu

¹¹Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania

¹²Clinical Immunology Department, Colentina Clinical Hospital, Bucharest, Romania

,

Claudia Diaconu

¹Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania

,

Bogdan Busuioc

¹⁰Gastroenterology Department, Cantacuzino Hospital, Bucharest, Romania

,

Ivo Boskoski

¹³Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy

¹⁴Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy

,

Andrei M. Voiosu

¹Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania

²Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania

,

Radu B. Mateescu

¹Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania

²Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania

,

Sachin Wani

¹⁵University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

› Institutsangaben

Abstract

Background Optimal training strategies in endoscopic retrograde cholangiopancreatography (ERCP) remain controversial despite the shift toward competence-based training models, with limited data available on patient safety during training. We aimed to assess whether pre-procedural clinical predictors could identify patients at low risk of developing procedure-related adverse-events (AEs) in a training environment.

Methods We performed a prospective, multicenter, cohort study in five training centers. A data collection system documenting indication, clinical data, trainee performance (assessed using a validated competence assessment tool), technical outcomes, and AEs over a 30-day follow-up was utilized. We developed a clinical risk score (Trainee Involvement in ERCP Risk Score [TIERS]) for patients undergoing ERCP and compared the rate of AEs in a training environment between low-risk and high-risk groups. The association between trainee performance and AE rate was also evaluated.

Results 1283 ERCPs (409 [31.9 %, 95 %CI 29.3 %–34.4 %] with trainee involvement) performed by 11 trainers and 10 trainees were analyzed. AEs were more frequent in the high-risk compared with the low-risk group: 26.7 % (95 %CI 20.5 %–34.7 %) vs. 17.1 % (95 %CI 12.8 %–22.2 %). TIERS demonstrated a high negative predictive value for AEs (82.9 %, 95 %CI 79.4 %–85.8 %) and was the only predictor of AEs on multivariable analysis (odds ratio 1.38, 95 %CI 1.09–1.75). Suboptimal trainee performance was associated with an increase in AE rates.

Conclusion Simple, clinical-based predictive tools could improve ERCP training by selecting the most appropriate cases for hands-on training, with the aim of increasing patient safety.

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Referenzen

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