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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Endoscopic retrograde cholangiopancreatography-related early perforations: A study of effects of procedure duration, complexity, and endoscopist experience
Mark Aloysius, Hemant Goyal, Tejas Nikumbh, Niraj James Shah, Ghassan M Hammoud, Pritesh Mutha, Mairin Joseph-Talreja, Savio John, Ganesh Aswath, Vaibhav Wadhwa, Nirav Thosani
Mark Aloysius, Savio John, Ganesh Aswath, Division of Gastroenterology, Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, United States
Hemant Goyal, Pritesh Mutha, Mairin Joseph-Talreja, Vaibhav Wadhwa, Nirav Thosani, Department of Surgery, The University of Texas Health Science Center, Houston, TX 77030, United States
Tejas Nikumbh, Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18510, United States
Niraj James Shah, Ghassan M Hammoud, Department of Medicine, Division of Digestive Diseases, The University of Missouri at Columbia, Columbia, MO 65211, United States
Author contributions: Aloysius M and Goyal H designed the study, performed the statistical analysis, generated the figures, and edited the manuscript; Nikumbh T performed the literature review and drafted the initial version of the manuscript and revised manuscript; Shah NJ, Hammoud GM, Mutha P, and Joseph-Talreja M edited the manuscript; John S, Aswath G, Wadhwa V and Thosani N critically reviewed manuscript.
Institutional review board statement: The Institutional review board approval was not needed for this study originating from a publicly available database.
Informed consent statement: As the study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at doc.hemant@yahoo.com.
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.
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: Hemant Goyal, MD, Instructor, Department of Surgery, The University of Texas Health Science Center, No. 6431 Fannin, MSB 4.152, Houston, TX 77030, United States. doc.hemant@yahoo.com
Received: April 28, 2023
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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
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.
Research methods
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.
Research results
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.
Research conclusions
Overall adverse events as a composite during ERCP are known to occur at a lower rate with higher volume endoscopists and centers.
Research perspectives
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.
