Introduction In recent years, systems grading ERCP technical difficulty have been introduced in UK clinical practice. According to these, small volume units are advised to refer complex cases to specialised centres. Conversely, in the US the American Society for Gastrointestinal Endoscopy (ASGE) has announced favourable results of community based hospitals ERCP success rates compared to university hospitals. Recommended competence rates are: 90% successful bile duct cannulation, 85% for bile duct stone removal and 90% for bile duct drainage of a blocked duct.1 In the UK, the J.R.B. Green and the UK ERCP stakeholders working party and Joint Advisory Group (JAG) suggest an overall 80% success rate.2 This study compares ERCP success rates in Nobles Hospital, a geographically isolated District General Hospital, to the competence rates of ASGE and JAG in order to assess whether ERCP can be performed successfully in district general hospitals in the UK.
Methods Between December 2010 and January 2012, 42 ERCPs were performed on 36 patients (F:M 24:12, Mean age: 69.8). All procedures were done for therapeutic purposes. Indications were divided to two categories: jaundice-stones identified in biliary ducts on pre procedural imaging (n=21) and jaundice-causes besides stones were identified in pre procedural imaging (n=21). χ2 Test was used to compare success ratios between Nobles Hospital and ASGE and JAG recommended levels.
Results Desired duct cannulation success rate was 88.1% (n=37). Success rate for stone removal was 80.95% (n=17). For bile duct drainage of a blocked duct was 85.7% (n=18). Had ASGE recommended rates been applied to our hospital's cases, the results would be: 38 out of 42, 18 out of 21 and 19 out of 21 respectively. No statistically significant difference was found between Nobles Hospital and ASGE figures (Successful cannulation p value=0.72, successful stone removal p value=0.68, successful blocked duct drainage=0.63). Overall success rate for Nobles was 83.3% (n=35).
Conclusion ERCP success rates in Nobles Hospital are equivalent to the ASGE/ACG Task Force recommended competency levels and exceed JAG recommended success rates. This study provides evidence that ERCP can be successfully performed in a non-specialised environment within the British National Health System.
Competing interests None declared.
References 1. ASGE publication. “Quality Outcomes and Complication Rates for ERCP in a Community Hospital Setting Compare Favourably With Academic Centres”. http://www.asge.org
2. Green JRB, the UK ERCP Stakeholders Working Party. The Future of Service and Training in ERCP in the UK—A Strategy. http://www.bsg.org.uk
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