A new study from researchers in Minnesota found that endoscopic retrograde cholangiopancreatography (ERCP) performed in a community hospital setting results in complication rates that compare favorably with those of academic centers while achieving technical success at or above the performance levels recommended by the American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology (ACG) Task Force. This is the first large study evaluating complications and quality indicators in a purely non-academic community practice. The study appears in the September issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy.
ERCP is a specialized technique used to study and treat problems of the ducts that drain the liver and pancreas. To reach the ducts, an endoscope is passed through the mouth, past the stomach and into the small intestine (duodenum). A thin tube is then inserted through the endoscope into the common bile duct and pancreatic duct connecting the liver and pancreas to the intestine. A contrast material (dye) is injected through the tube outlining those ducts while X-rays are being taken. The X-rays can show narrowing or blockages in the ducts that may be due to a cancer, gallstones or other abnormalities.
ERCP is technically challenging and is associated with the highest rate of complications among gastroenterological procedures. Because of the attendant risk of ERCP, cases that portend to be more complex are likely to be managed in academic medical centers. Therefore, much of the data regarding complications has been published from academic institutions. Rates of complications have not been well studied in community-based gastroenterology practices.
"This was a prospective study to determine the outcomes and complications of ERCP in a community practice using seven of the eight quality indicators outlined by ASGE, with particular attention to the 30-day complication rate," said study lead author Joshua B. Colton, MD, Minnesota Gastroenterology PA, Maplewood, Minn. "We found that the complication rate was five percent in this community practice, which is very favorable as we know that large ERCP studies from academic centers have documented complication rates of five to 15.9 percent. In addition, our success rates met or exceeded the recommended rates reported by the ASGE/ACG Task Force."
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