Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training?

  • Shyam Vedantam (Department of Medicine, University of Miami) ;
  • Sunil Amin (Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami) ;
  • Ben Maher (Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust) ;
  • Saqib Ahmad (Department of Gastroenterology, Sherwood Forest Hospitals NHS Foundation Trust) ;
  • Shanil Kadir (Department of Gastroenterology, Liaquat National Hospital and Medical College) ;
  • Saad Khalid Niaz (Interventional Endoscopy Unit, Surgical Unit 4, Dow University of Health Sciences) ;
  • Mark Wright (Southampton Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust) ;
  • Nadeem Tehami (Southampton Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust)
  • Received : 2021.09.23
  • Accepted : 2021.11.08
  • Published : 2022.05.30
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Abstract

Background/Aims: Cholangiogram interpretation is not used as a key performance indicator (KPI) of endoscopic retrograde cholangiopancreatography (ERCP) training, and national societies recommend different minimum numbers per annum to maintain competence. This study aimed to determine the relationship between correct ERCP cholangiogram interpretation and experience. Methods: One hundred fifty ERCPists were surveyed to appropriately interpret ERCP cholangiographic findings. There were three groups of 50 participants each: "Trainees," "Consultants group 1" (performed >75 ERCPs per year), and "Consultants group 2" (performed >100 ERCPs per year). Results: Trainees was inferior to Consultants groups 1 and 2 in identifying all findings except choledocholithiasis outside the intrahepatic duct on the initial or completion/occlusion cholangiogram. Consultants group 1 was inferior to Consultants group 2 in identifying Strasberg type A bile leaks (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.77-0.96), Strasberg type B (OR, 0.84; 95% CI, 0.74-0.95), and Bismuth type 2 hilar strictures (OR, 0.81; 95% CI, 0.69-0.95). Conclusions: This investigation supports the notion that cholangiogram interpretation improves with increased annual ERCP case volumes. Thus, a higher annual volume of procedures performed may improve the ability to correctly interpret particularly difficult findings. Cholangiogram interpretation, in addition to bile duct cannulation, could be considered as another KPI of ERCP training.

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Acknowledgement

This was an international survey project that would not have been possible without the help of colleagues around the world. Their participation in this project is appreciated.

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