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The assessment of the ASGE-grading system of ERCP: a large-sample retrospective study

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A Correction to this article was published on 19 January 2022

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Abstract

Background and aims

The American Society for Gastrointestinal Endoscopy (ASGE) has developed a complexity-grading system for endoscopic retrograde cholangiopancreatography (ERCP) to predict technical success and adverse events. This study aimed to assess the association between the degree of difficulty for ERCP and the rates of success and adverse event, in turn demonstrating the validity and practicality of this system.

Methods

ERCP procedures performed in the First Affiliated Hospital of Nanchang University from January 2011 to December 2020 were retrospectively reviewed. Procedural success and adverse events were recorded based on difficulty level according to the ASGE-grading system.

Results

A total of 20,652 ERCP procedures performed during the study period were analyzed, including 1908 procedures considered grade 1(9.2%), 10,170 procedures considered grade 2 (49.2%), 7764 procedures considered grade 3 (37.6%), 810 procedures considered grade 4 (3.9%). The overall success rate increased from 92.8% in 2011–2015 to 94.0% in 2016–2020, while the distribution of procedures and the incidence of complications showed little variation. The success rate revealed a significantly decreasing trend with increasing difficulty (ranging from 55.6 to 98.6%), mainly for biliary diseases. In addition, the difficulty scale was not associated with any differences in the rate of adverse event, except for the pancreatitis for grade 1 procedures, which had a low incidence.

Conclusions

The ASGE-grading system can help predict the success rate of ERCP procedures but showed poor performance in predicting adverse events. Further exploration may be required to improve the grading system by adjusting or including certain clinical parameters, and to validate the system for extrapolation to other endoscopy units.

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Change history

  • 19 January 2022

    This article was updated to correct an error in the Methods section of the Abstract: "from January 2010 to December 2019" was corrected to read "from January 2011 to December 2020".

  • 19 January 2022

    A Correction to this paper has been published: https://doi.org/10.1007/s00464-022-09055-7

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Acknowledgements

The authors are indebted to the staff of the Digestive Endoscope Center of the First Affiliated Hospital of Nanchang University for their Assistance in the implementation of this project.

Funding

The authors declare that no funding support was received for this study.

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Author notes

  1. Feng Zhou and Xiaoyun Zhan are first authors.

Authors and Affiliations

  1. Department of Gastroenterology, First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330000, Jiangxi Province, China

    Feng Zhou, Xiaoyun Zhan, Conghua Song, Guohua Li, Junbo Hong, Youxiang Chen & Xiaojiang Zhou

Authors
  1. Feng Zhou
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  2. Xiaoyun Zhan
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  3. Conghua Song
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  4. Guohua Li
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Contributions

FZ: study design, acquisition of data, drafting of the manuscript. XZ: acquisition of data. CS: interpretation of data, critical revision of the manuscript. GL, JH, YC: endoscopic procedures, critical revision of the manuscript. XZ: study design, endoscopic procedures, and critical revision of the manuscript. All authors have approved the publication of this article.

Corresponding author

Correspondence to Xiaojiang Zhou.

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Disclosures

Drs Feng Zhou, Xiaoyun Zhan, Conghua Song, Guohua Li, Junbo Hong, Youxiang Chen, and Xiaojiang Zhou have no conflicts of interest or financial ties to disclose.

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Zhou, F., Zhan, X., Song, C. et al. The assessment of the ASGE-grading system of ERCP: a large-sample retrospective study. Surg Endosc 36, 6480–6487 (2022). https://doi.org/10.1007/s00464-021-09000-0

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