Quality assurance assessment of ERCP laboratory with special regards to the endoscopic treatment of acute Biliary Pancreatitis

Background: The aim of this study was to perform a quality assurance type of assessment of our routine ERCP practice. A secondary objective was to reveal any benefit or disadvantage of deviation from the guideline in our practice of the treatment of biliary pancreatitis. Records of patients undergoing ERCP in 2014 were reviewed retrospectively with respect to indication of ERCP, technical and intention of treatment success, complication rate. 457 successful ERCPs were performed by 3 skilled gastroenterologists in 332 patients. We evaluated the data of a subgroup of 242 patients with native papilla of Vater in conformity with Quality Indicators for ERCP published by the ASGE in 2014. Results: The successful primary deep cannulation rate was 90.1%, which reaches requirement in ASGE guideline. In 18 (7.4%) patients cannulation was successful for the second or third trial and in 6 patients (2.5%) we failed to cannulate the necessary duct. Therapeutic ERCP was performed in 84.8% and diagnostic in 15.2% of 236 patients. The most common diagnosis were choledocholithiasis only, biliary pancreatitis, tumours and stenosis of papilla in 30.9%, 27.1%, 16.1%, 9.8%, of patients, respectively. The successful primary stone extraction rate was 91.4% meeting the ASGE recommendation. We performed biliary stenting in the remainder of patients. The adverse event rate was low; mild to moderate post-ERCP-pancreatitis in 1.3%, bleeding requiring transfusion in 0.8%, minor bleeding occurred in 2.1% patients. In 24 (10.1%) patients mild amylasaemia was detected without symptoms. Preventive pancreatic stent was inserted in 25% of patients. The subgroup of patients with biliary pancreatitis was analysed separately. The current guidelines suggest ERCP only in pancreatitis with cholangitis. Based on the TG13 criteria, out of 64 patients with pancreatitis, ERCP should have been done only in 15 patients with pancreatitis. Stone was found in 13 patients out of 15 (86.6%) cholangitis-positive; however, main bile duct stones were removed in 40 out of 49 (81.6%) patients without the signs of cholangitis. Major adverse event was not detected in any subgroups. Conclusion: We consider that quality assurance and quality control are important means of ensuring the quality of endoscopy especially if the indication of an intervention not strictly follows the guidelines. Our daily practice is authorized by our results.