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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Results of endoscopic retrograde cholangiopancreatography procedures at surgical clinics: A multicenter observational study in Türkiye
Sezgin Yilmaz, Esat Taylan Ugurlu, Alpen Yahya Gumusoglu, Mahmut Said Degerli, Kemal Dolay, Emre Balli, Yasin Kara, Ali Kocataş, Ekrem Çakar, Bünyamin Gürbulak, Sercan Yüksel, Soykan Arikan, Hasan Bektaş, Yusuf Emre Aytin, Doğan Albayrak, Ali Fuat Kaan Gok, Cemalettin Ertekin, Alpaslan Fedayi Çalta, Serhat Oğuz, Mustafa Örmeci, Ali Haldun Özcan, Barış Sevinç, Ömer Karahan, İhsan Tümkaya, Osman Kones, Mehlika Bilgi Kirmaci, Mustafa Yavuz, Emrah Akın, Merve Yeşilsancak
Sezgin Yilmaz, Emre Balli, Mehlika Bilgi Kirmaci, Health, Education and Research Center, Afyonkarahisar Health Sciences University, Afyonkarahisar 03100, Türkiye
Esat Taylan Ugurlu, Health Sciences University, Mehmet Akif Inan Training and Research Hospital, Sanlıurfa 63040, Türkiye
Alpen Yahya Gumusoglu, Mahmut Said Degerli, Kemal Dolay, Osman Kones, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul 34147, Türkiye
Yasin Kara, Ali Kocataş, Health Sciences University, Kanunı Sultan Suleyman Traınıng & Research Hospıtal, Istanbul 34303, Türkiye
Ekrem Çakar, Bünyamin Gürbulak, Istanbul Training and Research Hospital, Istanbul 34098, Türkiye
Sercan Yüksel, Soykan Arikan, Başakşehir Çam and Sakura City Hospital, Istanbul 34480, Türkiye
Hasan Bektaş, Medicana Zincirlikuyu Hospital, Istanbul 34098, Türkiye
Yusuf Emre Aytin, Doğan Albayrak, Faculty of Medicine, Trakya University, Edirne 22030, Türkiye
Ali Fuat Kaan Gok, Cemalettin Ertekin, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Türkiye
Alpaslan Fedayi Çalta, Serhat Oğuz, Faculty of Medicine, Bandırma 17 Eylül University, Balıkesir 100200, Türkiye
Mustafa Örmeci, Ali Haldun Özcan, Bandırma Training and Research Hospital, Bandırma 100200, Türkiye
Barış Sevinç, Ömer Karahan, Faculty of Medicine, Uşak University, Uşak 64100, Türkiye
İhsan Tümkaya, Prof. Dr. Alaeddin Yavaşça State Hospital, Kilis 79000, Türkiye
Mustafa Yavuz, Tarsus MMT American Hospital, Istanbul 33400, Türkiye
Emrah Akın, Merve Yeşilsancak, Faculty of Medicine, Sakarya University, Sakarya 54050, Türkiye
Author contributions: Yilmaz S, Ugurlu ET designed and prepared the study, collected data and wrote the manuscript; Gumusoglu AY, Degerli MS, Dolay K, Balli E, Kara Y, Kocataş A, Çakar E, Gürbulak B, Yüksel S, Arikan S, Bektaş H, Aytin YE, Albayrak D, Gok AFK, Ertekin C, Çalta AF, Oğuz S, Örmeci M, Özcan AH, Sevinç B, Karahan Ö, Tümkaya İ, Kones O, Bilgi Kirmaci M, Yavuz M, Akın E, and Yeşilsancak M contributed to collection of the data and preparation of the manuscript.
Institutional review board statement: The study has been approved by Ethics Committee Meeting: Harran University Clinical Research Ethics Committee decision date (30.12.2024), sessions (21), time (13.30).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Since no new data were created or analyzed in this study, data sharing does not apply to this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Esat Taylan Ugurlu, Health Sciences University, Mehmet Akif Inan Training and Research Hospital, Ertugrulgazi Mahallesi, Merkez, Esentepe Caddesi, 308 Sokak 32/A, Haliliye, Sanlıurfa 63040, Türkiye.
esattaylanugurlu@gmail.com
Received: January 2, 2025
Revised: February 24, 2025
Accepted: March 18, 2025
Published online: May 27, 2025
Processing time: 142 Days and 18.2 Hours
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary (HPB) diseases. The need for ERCP has increased with the rising number of HPB diseases over the past decade. Thus, due to increased demand, ERCP is performed at more centers. Currently, it is performed by general surgeons, gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology (BSG).
AIM
To present the results of ERCP procedures from fourteen surgical centers in Türkiye.
METHODS
Fourteen surgical centers performing ERCP were included in the present study. The age, gender, ERCP indication, success status, post-ERCP complications, ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers. The results are discussed according to the targets declared by the BSG, which are volume load per annum, proportion of successful cannulation (> 85%), bile duct clearance rate (> 75%), stenting rate for strictures (> 80%) and complications (< 6%).
RESULTS
A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024. 29250 (43.6%) of the procedures were performed urgently, especially for suppurative cholangitis, biliary tract injuries, etc. The remaining 37743 (56.4%) cases were performed electively. 50.2% of the patients were female and 49.8% were male. The average ages were 56.5 years for women and 55.9 years for men. General anesthesia was used in 84.1% of the patients while sedation was used in 15.9%. The indications were bile duct stone (78.7%), pancreatic tumor (3.9%), papillary tumor (3.3%), cholangiocarcinoma (2.6%), Oddi sphincter dysfunction (2.4%), bile leakage after cholecystectomy (2%), bile leakage after hydatid cyst surgery (1.9%), biliary stricture (1.7%), and other diseases (3.1%). Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1% of the patients. They were usually self-limited and responded to supportive measures. The frequency of the other complications was also consistent with the literature.
CONCLUSION
There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries. As patients requiring ERCP usually present to surgical practitioners, the incorporation of surgeons into this training program is an effective and reliable solution. The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists. This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye. The results suggest that the surgical centers included were able to achieve the targets set by the BSG. This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service. There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP. Therefore, ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.
Core Tip: The present article assesses the results of all endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in fourteen surgical centers included in the study. This study was a retrospective, multicenter, observational study and no statistical evaluation was performed. Age, gender, ERCP indication, success status, post-ERCP complications, ERCP reports and the medical files of 66993 patients who underwent ERCP were collected from these centers. The results are discussed according to the targets announced by British Society of Gastroenterology, which are annual volume load, successful cannulation rate (> 80%), bile duct clearance rate (> 75%), stent rate for stenoses (> 85%) and complications (< 6%). All patients who underwent ERCP in the participating centers were included in the study. Both elective and emergency procedures were recorded and there were no exclusion criteria.
