Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice
- Earl J Williams1,
- Steve Taylor2,
- Peter Fairclough3,
- Adrian Hamlyn4,
- Richard F Logan5,
- Derrick Martin6,1,
- Stuart A Riley7,
- Peter Veitch8,2,
- Mark Wilkinson9,
- Paula J Williamson2,
- Martin Lombard1,
- on behalf of participating units, BSG Audit of ERCP
- 1Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
- 2Centre for Medical Statistics and Health Evaluation, School of Health Sciences, University of Liverpool, Liverpool, UK
- 3Department of Gastroenterology, Barts and The London NHS Trust, London, UK
- 4Department of Gastroenterology, Russell’s Hall Hospital, Dudley, West Midlands, UK
- 5Division of Epidemiology and Public Health, Queen’s Medical Centre, Nottingham, UK
- 6Department of Radiology, Wythenshawe Hospital, Manchester, UK
- 7Department of Gastroenterology, Northern General Hospital, Sheffield, UK
- 8Department of Surgery, Royal Free Hospital, London, UK
- 9Department of Gastroenterology, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Correspondence to:
Dr M Lombard
Audit Steering Group, Department of Gastroenterology, 5z Link, Royal Liverpool University Hospital, Prescot St, Liverpool L7 8XP, UK;
- Accepted 17 October 2006
- Revised 20 September 2006
- Published Online First 4 December 2006
Objective: To examine endoscopic retrograde cholangio-pancreatography (ERCP) services and training in the UK.
Design: Prospective multicentre survey.
Setting: Five regions of England.
Participants: Hospitals with an ERCP unit.
Outcome measures: Adherence to published guidelines, technical success rates, complications and mortality.
Results: Organisation questionnaires were returned by 76 of 81 (94%) units. Personal questionnaires were returned by 190 of 213 (89%) ERCP endoscopists and 74 of 91 (81%) ERCP trainees, of whom 45 (61%) reported participation in <50 ERCPs per annum. In all, 66 of 81 (81%) units collected prospective data on 5264 ERCPs, over a mean period of 195 days. Oximetry was used by all units, blood pressure monitoring by 47 of 66 (71%) and ECG monitoring by 37 of 66 (56%) units; 1484 of 4521 (33%) patients were given >5 mg of midalozam. Prothrombin time was recorded in 4539 of 5264 (86%) procedures. Antibiotics were given in 1021 of 1412 (72%) cases, where indicated. Patients’ American Society of Anesthesiology (ASA) scores were 3–5 in 670 of 5264 (12.7%) ERCPs, and 4932 of 5264 (94%) ERCPs were scheduled with therapeutic intent. In total, 140 of 182 (77%) trained endoscopists demonstrated a cannulation rate ⩾80%. The recorded cannulation rate among senior trainees (with an experience of >200 ERCPs) was 222/338 (66%). Completion of intended treatment was done in 3707 of 5264 (70.4%) ERCPs; 268 of 5264 (5.1%) procedures resulted in a complication. Procedure-related mortality was 21/5264 (0.4%). Mortality correlated with ASA score.
Conclusion: Most ERCPs in the UK are performed on low-risk patients with therapeutic intent. Complication rates compare favourably with those reported internationally. However, quality suffers because there are too many trainees in too many low-volume ERCP centres.
- ASA, American Society of Anesthesiology
- BSG, British Society of Gastroenterology
- ERCP, endoscopic retrograde cholangio-pancreatography
- NCEPOD, National Confidential Enquiry into Patient Outcome and Death
↵1 Represented the Royal College of Radiologists, UK
↵2 Represented the Association of Upper G1 Surgeons, UK
Published Online First 1 December 2006
Funding: This project was sponsored and funded by the British Society of Gastroenterology.
Competing interests: None.
Ethical approval: This project was approved by the West Midlands MREC on 4 August 2003: reference number MREC 03/7/051.