Surgical Endoscopy

, Volume 32, Issue 6, pp 2871–2876 | Cite as

Surgeon-performed endoscopic retrograde cholangiopancreatography. Outcomes of 2392 procedures at two tertiary care centers

  • Mazen R. Al-Mansour
  • Eleanor C. Fung
  • Edward L. Jones
  • Nichole E. Zayan
  • Timothy D. Wetzel
  • Sara E. Martin del Campo
  • Anahita D. Jalilvand
  • Andrew J. Suzo
  • Rebecca R. Dettorre
  • James K. Fullerton
  • Michael P. Meara
  • John D. Mellinger
  • Vimal K. Narula
  • Jeffrey W. Hazey
Article

Abstract

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure that, in the United States, is traditionally performed by gastroenterologists. We hypothesized that when performed by well-trained surgeons, ERCP can be performed safely and effectively. The objectives of the study were to assess the rate of successful cannulation of the duct of interest and to assess the 30-day complication and mortality rates.

Methods

We retrospectively reviewed the charts of 1858 patients who underwent 2392 ERCP procedures performed by five surgeons between August 2003 and June 2016 in two centers. Demographic and historical data, indications, procedure-related data and 30-day complication and mortality data were collected and analyzed.

Results

The mean age was 53.4 (range 7–102) years and 1046 (56.3%) were female. 1430 (59.8%) of ERCP procedures involved a surgical endoscopy fellow. The most common indication was suspected or established uncomplicated common bile duct stones (n = 1470, 61.5%), followed by management of an existing biliary or pancreatic stent (n = 370, 15.5%) and acute biliary pancreatitis (n = 173, 7.2%). A therapeutic intervention was performed in 1564 (65.4%), a standard sphincterotomy in 1244 (52.0%), stent placement in 705 (29.5%) and stone removal in 638 (26.7%). When cannulation was attempted, the rate of successful cannulation was 94.1%. When cannulation was attempted during the patient’s first ERCP the cannulation rate was 92.4%. 94 complications occurred (5.4%); the most common complication was post-ERCP pancreatitis in 75 (4.2%), significant gastrointestinal bleeding in 7 (0.4%), ascending cholangitis in 11 (0.6%) and perforation in 1 (0.05%). 11 mortalities occurred (0.5%) but none of which were ERCP-related.

Conclusion

When performed by well-trained surgical endoscopists, ERCP is associated with high success rate and acceptable complication rates consistent with previously published reports and in line with societal guidelines.

Keywords

ERCP ERC Endoscopic retrograde cholangiopancreatography Surgical endoscopy ERCP outcomes 

Notes

Acknowledgements

The authors thank Nathan LaFayette, Teresa Jones, Morgan White, Lauren Hughes, and Breana Lovell for their help in data collection.

Compliance with ethical standards

Disclosures

Mazen R. Al-Mansour, Eleanor C. Fung, Edward L. Jones, Nichole E. Zayan, Timothy D. Wetzel, Sara E. Martin del Campo, Anahita D. Jalilvand, Andrew J. Suzo, Rebecca R. Dettorre, James K. Fullerton, Michael P. Meara, John D. Mellinger, Vimal K. Narula, and Jeffrey W. Hazey have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    ASGE Standards of Practice Committee, Faulx AL, Lightdale JR, Acosta RD, Agrawal D, Bruining DH, Chandrasekhara V, Eloubeidi MA, Fanelli RD, Gurudu SR, Kelsey L, Khashab MA, Kothari S, Muthusamy VR, Qumseya BJ, Shaukat A, Wang A, Wani SB, Yang J, DeWitt JM (2017) Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy. Gastrointest Endosc 85:273–281.  https://doi.org/10.1016/j.gie.2016.10.036 CrossRefGoogle Scholar
  2. 2.
    Springer J, Enns R, Romagnuolo J, Ponich T, Barkun AN, Armstrong D (2008) Canadian credentialing guidelines for endoscopic retrograde cholangiopancreatography. Can J Gastroenterol J Can Gastroenterol 22:547–551CrossRefGoogle Scholar
  3. 3.
    Shahidi N, Ou G, Telford J, Enns R (2015) When trainees reach competency in performing ERCP: a systematic review. Gastrointest Endosc 81:1337–1342.  https://doi.org/10.1016/j.gie.2014.12.054 CrossRefPubMedGoogle Scholar
  4. 4.
    Ekkelenkamp VE, Koch AD, Rauws EAJ, Borsboom GJJM., de Man RA, Kuipers EJ (2014) Competence development in ERCP: the learning curve of novice trainees. Endoscopy 46:949–955.  https://doi.org/10.1055/s-0034-1377930 CrossRefPubMedGoogle Scholar
  5. 5.
    Jowell PS, Baillie J, Branch MS, Affronti J, Browning CL, Bute BP (1996) Quantitative assessment of procedural competence. A prospective study of training in endoscopic retrograde cholangiopancreatography. Ann Intern Med 125:983–989CrossRefPubMedGoogle Scholar
  6. 6.
    Adler DG, Lieb JG, Cohen J, Pike IM, Park WG, Rizk MK, Sawhney MS, Scheiman JM, Shaheen NJ, Sherman S, Wani S (2015) Quality indicators for ERCP. Gastrointest Endosc 81:54–66.  https://doi.org/10.1016/j.gie.2014.07.056 CrossRefPubMedGoogle Scholar
  7. 7.
    Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM (1996) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335:909–918.  https://doi.org/10.1056/NEJM199609263351301 CrossRefPubMedGoogle Scholar
  8. 8.
    Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F, De Berardinis F, De Bernardin M, Ederle A, Fina P, Fratton A (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48:1–10CrossRefPubMedGoogle Scholar
  9. 9.
    DeBenedet AT, Elmunzer BJ, McCarthy ST, Elta GH, Schoenfeld PS (2013) Intraprocedural quality in endoscopic retrograde cholangiopancreatography: a meta-analysis. Am J Gastroenterol 108:1696–1704.  https://doi.org/10.1038/ajg.2013.217quiz 1705.CrossRefPubMedGoogle Scholar
  10. 10.
    Flexible Endoscopy Curriculum | American Board of Surgery. http://www.absurgery.org/default.jsp?certgsqe_fec. Accessed 27 Jun 2017
  11. 11.
    Wexner SD, Garbus JE, Singh JJ, SAGES Colonoscopy Study Outcomes Group (2001) A prospective analysis of 13,580 colonoscopies. Re-evaluation of credentialing guidelines. Surg Endosc 15:251–261.  https://doi.org/10.1007/s004640080147 CrossRefPubMedGoogle Scholar
  12. 12.
    Reed WP, Kilkenny JW, Dias CE, Wexner SD, SAGES EGD Outcomes Study Group (2004) A prospective analysis of 3525 esophagogastroduodenoscopies performed by surgeons. Surg Endosc 18:11–21.  https://doi.org/10.1007/s00464-003-8913-3 CrossRefPubMedGoogle Scholar
  13. 13.
    Meguid A, Scheeres DE, Mellinger JD (1998) Endoscopic retrograde cholangiopancreatography in a general surgery training program. Am Surg 64:622–625 (discussion 625–626)PubMedGoogle Scholar
  14. 14.
    Vitale GC, Zavaleta CM, Vitale DS, Binford JC, Tran TC, Larson GM (2006) Training surgeons in endoscopic retrograde cholangiopancreatography. Surg Endosc 20:149–152.  https://doi.org/10.1007/s00464-005-0308-1 CrossRefPubMedGoogle Scholar
  15. 15.
    Cooper J, Desai S, Scaife S, Gonczy C, Mellinger J (2016) Volume, specialty background, practice pattern, and outcomes in endoscopic retrograde cholangiopancreatography: an analysis of the national inpatient sample. Surg Endosc.  https://doi.org/10.1007/s00464-016-5312-0 PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Mazen R. Al-Mansour
    • 1
  • Eleanor C. Fung
    • 1
  • Edward L. Jones
    • 2
  • Nichole E. Zayan
    • 1
  • Timothy D. Wetzel
    • 1
  • Sara E. Martin del Campo
    • 1
  • Anahita D. Jalilvand
    • 1
  • Andrew J. Suzo
    • 1
  • Rebecca R. Dettorre
    • 1
  • James K. Fullerton
    • 3
  • Michael P. Meara
    • 1
  • John D. Mellinger
    • 3
  • Vimal K. Narula
    • 1
  • Jeffrey W. Hazey
    • 1
  1. 1.Department of SurgeryThe Ohio State University/Wexner Medical CenterColumbusUSA
  2. 2.Department of Surgery, Denver Veterans Affairs Medical CenterUniversity of ColoradoDenverUSA
  3. 3.Department of General SurgerySouthern Illinois University School of MedicineSpringfieldUSA

Personalised recommendations