Clin Endosc.  2022 May;55(3):426-433. 10.5946/ce.2021.239.

Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training?

• Vedantam S
• Amin S
• Maher B
• Ahmad S
• Kadir S
• Niaz SK
• Wright M
• Tehami N

• KMID: 2529965
• DOI: http://doi.org/10.5946/ce.2021.239

Abstract

Background/Aims
Cholangiogram interpretation is not used as a key performance indicator (KPI) of endoscopic retrograde cholangiopancreatography (ERCP) training, and national societies recommend different minimum numbers per annum to maintain competence. This study aimed to determine the relationship between correct ERCP cholangiogram interpretation and experience.
Methods
One hundred fifty ERCPists were surveyed to appropriately interpret ERCP cholangiographic findings. There were three groups of 50 participants each: “Trainees,” “Consultants group 1” (performed >75 ERCPs per year), and “Consultants group 2” (performed >100 ERCPs per year).
Results
Trainees was inferior to Consultants groups 1 and 2 in identifying all findings except choledocholithiasis outside the intrahepatic duct on the initial or completion/occlusion cholangiogram. Consultants group 1 was inferior to Consultants group 2 in identifying Strasberg type A bile leaks (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.77–0.96), Strasberg type B (OR, 0.84; 95% CI, 0.74–0.95), and Bismuth type 2 hilar strictures (OR, 0.81; 95% CI, 0.69–0.95).
Conclusions
This investigation supports the notion that cholangiogram interpretation improves with increased annual ERCP case volumes. Thus, a higher annual volume of procedures performed may improve the ability to correctly interpret particularly difficult findings. Cholangiogram interpretation, in addition to bile duct cannulation, could be considered as another KPI of ERCP training.

Keyword

Cholangiograms; Endoscopic retrograde cholangiopancreatography; Key performance indicators; Training

Figure

• 

  Fig. 1. Cholangiogram images sent in survey. Images were sent in the open-ended questionnaire. (A) Bile leak 1 (Strasberg type A). (B) Bile leak 2 (Strasberg type B). (C) Hilar stricture 1 (Bismuth type 1). (D) Hilar stricture 2 (Bismuth type 1). (E) Hilar stricture 3 (Bismuth type 2). (F) Distal CBD stricture. (G) Choledocholithiasis 1 (IC; stone size >10 mm). (H) Choledocholithiasis 1 (CC; stone size >10 mm). (I) Choledocholithiasis 2 (IC; stone size <10 mm). (J) Choledocholithiasis 2 (CC; stone size <10 mm). (K) Choledocholithiasis 3 (IC; IHD calculus). (L) Choledocholithiasis 3 (CC; IHD stone). (M) Normal (mildly dilated CBD). CBD, common bile duct; IC, initial cholangiogram; CC, completion/occlusion cholangiogram; IHD, intrahepatic duct.

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