TY - JOUR
T1 - Association Between Endoscopist and Center Endoscopic Retrograde Cholangiopancreatography Volume With Procedure Success and Adverse Outcomes
T2 - A Systematic Review and Meta-analysis
AU - Keswani, Rajesh N.
AU - Qumseya, Bashar J.
AU - O'Dwyer, Linda C.
AU - Wani, Sachin
N1 - Publisher Copyright:
© 2017 AGA Institute
PY - 2017/12
Y1 - 2017/12
N2 - Background & Aims Endoscopic retrograde cholangiopancreatography (ERCP) has become a predominantly therapeutic intervention with a resultant increase in complexity. The relationship between ERCP volume and outcomes is unclear. We aimed to conduct a systematic review and meta-analysis assessing the relationship between endoscopist and center ERCP volume with ERCP success and adverse event (AE) rates. Methods A comprehensive search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted from inception to January 2017. Studies providing outcomes stratified by endoscopist and/or center volume were included in the final analysis. Endoscopist/center volume was stratified as low volume (LV) and high volume (HV). The definition of ERCP success varied between studies. The overall AE rate was a composite rate including pancreatitis, perforation, and bleeding. Results A literature search resulted in 1264 citations. Of those, 13 articles (n = 59,437 ERCPs) met inclusion criteria. LV endoscopist (<25 to <156 annual ERCPs) and center (<87 to <200 annual ERCPs) definitions varied between studies. HV endoscopists were significantly more likely to achieve ERCP success compared with LV endoscopists (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2–2.1). HV centers were significantly more likely to achieve ERCP success (OR, 2; 95% CI, 1.6–2.5). The post-ERCP AE risk was lower for HV endoscopists (OR, 0.7; 95% CI, 0.5–0.8) but not HV centers (OR, 0.7; 95% CI, 0.3–1.5). Conclusions This study identifies a significant relationship between increasing endoscopist and center ERCP volume with overall procedure success. Increasing endoscopist volume also was associated with a decreased AE rate. Given these compelling findings, we propose that providers and payers consider consolidating ERCP to HV endoscopists to improve ERCP outcomes and value.
AB - Background & Aims Endoscopic retrograde cholangiopancreatography (ERCP) has become a predominantly therapeutic intervention with a resultant increase in complexity. The relationship between ERCP volume and outcomes is unclear. We aimed to conduct a systematic review and meta-analysis assessing the relationship between endoscopist and center ERCP volume with ERCP success and adverse event (AE) rates. Methods A comprehensive search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted from inception to January 2017. Studies providing outcomes stratified by endoscopist and/or center volume were included in the final analysis. Endoscopist/center volume was stratified as low volume (LV) and high volume (HV). The definition of ERCP success varied between studies. The overall AE rate was a composite rate including pancreatitis, perforation, and bleeding. Results A literature search resulted in 1264 citations. Of those, 13 articles (n = 59,437 ERCPs) met inclusion criteria. LV endoscopist (<25 to <156 annual ERCPs) and center (<87 to <200 annual ERCPs) definitions varied between studies. HV endoscopists were significantly more likely to achieve ERCP success compared with LV endoscopists (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2–2.1). HV centers were significantly more likely to achieve ERCP success (OR, 2; 95% CI, 1.6–2.5). The post-ERCP AE risk was lower for HV endoscopists (OR, 0.7; 95% CI, 0.5–0.8) but not HV centers (OR, 0.7; 95% CI, 0.3–1.5). Conclusions This study identifies a significant relationship between increasing endoscopist and center ERCP volume with overall procedure success. Increasing endoscopist volume also was associated with a decreased AE rate. Given these compelling findings, we propose that providers and payers consider consolidating ERCP to HV endoscopists to improve ERCP outcomes and value.
KW - Adverse Events
KW - ERCP
KW - Endoscopic Retrograde Cholangiopancreatography
KW - Pancreatitis
KW - Success Rates
KW - Volume
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U2 - 10.1016/j.cgh.2017.06.002
DO - 10.1016/j.cgh.2017.06.002
M3 - Review article
C2 - 28606848
AN - SCOPUS:85030783120
SN - 1542-3565
VL - 15
SP - 1866-1875.e3
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 12
ER -