Introduction A trainee endoscopist on the ERCP list prolongs procedure time and may increase risk of technical failure or procedural complications.1,2Recent BSG guidance has identified a biliary cannulation rate of 90% as an ERCP performance indicator which may conflict with the need to train juniors. This prospective audit assessed the impact of an endoscopy trainee on the overall biliary cannulation rates.
Method We prospectively audited sequential ERCPs done on a “virgin” ampulla (no previous ERCP). Procedures were supervised by 2 experienced trainers; trainees were present when possible (trainees were senior SpRs with limited ERCP experience). A short-wire system was used for biliary cannulation and standard techniques used.1The trainee would have 6 min to achieve biliary cannulation, failing which the trainer would take over. Predicted ERCP difficulty was graded using accepted criteria.3The primary outcome was the biliary cannulation rate.
Results One hundred and eight sequential ERCPs were prospectively audited over a period of 6 months [July 2014–Dec 2014]. Difficulty was graded as 1 (n = 69] or 2 [n = 39]. One of two trainee endoscopists was present during 61[56%] ERCP cases; remaining cases were done by a consultant alone [n = 47, 44%]. Deep biliary cannulation was successful in 99 cases [91%]. The cannulation rate was 93% [57/61] with a trainee and 89% [42/47] without[p = 0.7229 Fishers exact test] Median cannulation time was 6.6 min (range 1–25). There was no significant difference in cannulation times when a trainee was present[T test, p = 0.890]. Where a trainee was involved, 20/61[32%] cannulations were achieved independently by the trainee. There were no major complications recorded in cases where a trainee was involved.
Conclusion This audit suggested that acceptable biliary cannulation rates can be achieved on ERCP training lists, with involvement of experienced trainers and defined training parameters.
Disclosure of interest None Declared.
Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–18
Shekhar, Shetty, Fisher BSG 2014 (abstract)
SchutzSM, AbbottRM. Grading ERCPs by degree of difficulty: a new concept to produce more meaningful outcome data. Gastrointest Endosc. 2000;51(5):535–9