KMID : 1188320200140020257
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Gut and Liver 2020 Volume.14 No. 2 p.257 ~ p.264
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Impact of Hospital Volume and the Experience of Endoscopist on Adverse Events Related to Endoscopic Retrograde Cholangiopancreatography: A Prospective Observational Study
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Lee Hyun-Jik
Cho Chang-Min Heo Jun Jung Min-Kyu Kim Tae-Nyeun Kim Kook-Hyun Kim Hyun-Soo Cho Kwang-Bum Kim Ho-Gak Han Ji-Min Lee Dong-Wook Lee Yoon-Suk
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Abstract
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Background/Aims: Few studies have addressed the relationship between the occurrence of adverse events (AEs) in endoscopic retrograde cholangiopancreatography (ERCP) and hospital case volume or endoscopist¡¯s experience with inconsistent results. The aim of our study was to investigate the impact of hospital case volume and endoscopist¡¯s experience on the AEs associated with ERCP and to analyze patient- and procedure-related risk factors for post-ERCP AEs.
Methods: From January 2015 to December 2015, we prospectively enrolled patients with naive papilla who underwent ERCP at six centers. Patient- and procedure-related variables were recorded on data collection sheets at the time of and after ERCP.
Results: A total of 1,191 patients (median age, 71 years) were consecutively enrolled. The overall success rate of biliary cannulation was 96.6%. Overall, 244 patients (20.5%) experienced post-ERCP AEs, including pancreatitis (9.0%), bleeding (11.8%), perforation (0.4%), cholangitis (1.2%), and others (0.9%). While post-ERCP pancreatitis (PEP) was more common when the procedure was performed by less experienced endoscopists, bleeding was more common in high-volume centers and by less experienced endoscopists. Multivariate analysis showed that a less experience in ERCP was significantly associated with PEP (odds ratio [OR], 1.630; 95% confidence interval [CI], 1.050 to 2.531; p=0.030) and post-ERCP bleeding (OR, 1.439; 95% CI, 1.003 to 2.062; p=0.048).
Conclusions: Our study demonstrated that overall AEs following ERCP were associated with the experience of the endoscopist. To minimize post-ERCP AEs, rigorous training with a sufficient case volume is required, and treatment strategies should be modified according to the endoscopist¡¯s expertise.
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KEYWORD
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Cholangiopancreatography, endoscopic retrograde, Adverse events, Hospital volume, Endoscopic experience
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