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  • Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice

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Pancreas and biliary tract
Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice
  1. Earl J Williams1,
  2. Steve Taylor2,
  3. Peter Fairclough3,
  4. Adrian Hamlyn4,
  5. Richard F Logan5,
  6. Derrick Martin6,1,
  7. Stuart A Riley7,
  8. Peter Veitch8,2,
  9. Mark Wilkinson9,
  10. Paula J Williamson2,
  11. Martin Lombard1,
  12. on behalf of participating units, BSG Audit of ERCP
  1. 1Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
  2. 2Centre for Medical Statistics and Health Evaluation, School of Health Sciences, University of Liverpool, Liverpool, UK
  3. 3Department of Gastroenterology, Barts and The London NHS Trust, London, UK
  4. 4Department of Gastroenterology, Russell’s Hall Hospital, Dudley, West Midlands, UK
  5. 5Division of Epidemiology and Public Health, Queen’s Medical Centre, Nottingham, UK
  6. 6Department of Radiology, Wythenshawe Hospital, Manchester, UK
  7. 7Department of Gastroenterology, Northern General Hospital, Sheffield, UK
  8. 8Department of Surgery, Royal Free Hospital, London, UK
  9. 9Department of Gastroenterology, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
  1. Correspondence to:
    Dr M Lombard
    Audit Steering Group, Department of Gastroenterology, 5z Link, Royal Liverpool University Hospital, Prescot St, Liverpool L7 8XP, UK; martin.lombard{at}rlbuht.nhs.uk

Abstract

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

https://doi.org/10.1136/gut.2006.097543

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    Footnotes

    • ↵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.

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