Published online Nov 16, 2023. doi: 10.4253/wjge.v15.i11.641
Peer-review started: April 28, 2023
First decision: July 4, 2023
Revised: August 6, 2023
Accepted: September 27, 2023
Article in press: September 27, 2023
Published online: November 16, 2023
Processing time: 195 Days and 23.8 Hours
Endoscopic retrograde cholangiopancreatography (ERCP) is a widely performed procedure in gastroenterology. ERCP perforations (Perf) are rare complication however they lead to severe morbidity and can be fatal.
Clinical outcomes research initiative-national endoscopic database (CORI-NED) is a large prospectively accrued population-based database maintained by national institute of health (NIH). NIH established CORI in 1995 to study the use and outcomes of endoscopy in diverse gastroenterology practice settings in the United States. Our motivation was to study this large database and look into the complications associated with ERCP.
ERCP were stratified based on the endoscopist and center volume (quartiles), complexity of the ERCP and total procedure duration based on procedure details. The effects of these variables on the Perf were studied.
ERCP related data from CORI NED database from 2000-2012 was analyzed. Continuous variables were compared between Perf and no Perf (NoPerf) groups using Mann-Whitney U test as the data demonstrated significant skewness and Kurtosis.
14153 ERCPs performed by 258 endoscopists at 48 facilities were analyzed. 20 Perfs (0.14%) were reported among 16 endoscopists. The cannulation rate for Perfs vs no Perfs was 100% and 91.5%, respectively. 11/20 (55%) of Perfs happened in the centres with the greatest volumes (4th quartile), while 13/20 (65%) of endoscopists were high-volume achievers. Total procedure duration in minutes was 60.1 ± 29.9 vs. 40.33 ± 23.5 (Perf vs. NoPerf, P < 0.001). Half of the procedures were complex and more than grade 1 difficulty (Table 1). 3 out of 20 (15%) patients had prior biliary surgery. 13 out of 20 cases (65%) had sphincterotomies with stent insertion. 1 case (0.5%) had peritonitis.
Overall adverse events as a composite during ERCP are known to occur at a lower rate with higher volume endoscopists and centers.
We analyzed the profile of Perfs related to ERCP from the CORI-NED database over 12 years. The retrospective analysis of 14153 ERCPs performed by 258 endoscopists reported 20 Perfs (0.14%) among 16 endoscopists. The cannulation rate was 100% for Perf and 91.5% for no Perf groups. 65% of endoscopists were high-volume performers, and 55% of Perfs occurred in centers with the highest volumes (4th quartile). Higher volume endoscopists and centres are known to have less ERCP-related adverse events. However, this national database study on Perfs has shown prolonged and complex procedures performed by high-volume endoscopists at high-volume centers contributed to Perfs.