Association Between Endoscopist and Center Endoscopic Retrograde Cholangiopancreatography Volume With Procedure Success and Adverse Outcomes: A Systematic Review and Meta-analysis

Rajesh N. Keswani*, Bashar J. Qumseya, Linda C. O'Dwyer, Sachin Wani

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1866-1875.e3
JournalClinical Gastroenterology and Hepatology
Volume15
Issue number12
DOIs
StatePublished - Dec 2017

Keywords

  • Adverse Events
  • ERCP
  • Endoscopic Retrograde Cholangiopancreatography
  • Pancreatitis
  • Success Rates
  • Volume

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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