Endoscopy 2020; 52(02): 115-122
DOI: 10.1055/a-1049-0359
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Impact of trainee involvement on the outcome of ERCP procedures: results of a prospective multicenter observational trial

Theodor Voiosu
1  Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
2  Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania
,
Ivo Boskoski
3  Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
4  Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
,
Andrei M. Voiosu
1  Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
,
Andreea Benguș
1  Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
,
Agata Ladic
5  University Hospital Centre, Zagreb, Croatia
,
Ivo Klarin
6  Gastroenterology Department, Zadar General Hospital, Zadar, Croatia
,
Vincenzo Bove
3  Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
4  Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
,
Bogdan Busuioc
7  Endoscopy Division, Cantacuzino Clinical Hospital, Bucharest, Romania
,
Mihai Rimbaș
1  Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
2  Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania
,
Nadan Rustemovic
5  University Hospital Centre, Zagreb, Croatia
,
Bogdan Mateescu
1  Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
2  Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania
,
Ivan Jovanovic
8  Clinic for Gastroenterology and Hepatology, University of Belgrade Medical School, Belgrade, Serbia
,
Guido Costamagna
3  Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
4  Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
› Author Affiliations
Further Information

Publication History

submitted 22 July 2019

accepted after revision 25 October 2019

Publication Date:
25 November 2019 (online)

Abstract

Background Training in advanced endoscopic techniques such as endoscopic retrograde cholangiopancreatography (ERCP) should be driven by key performance measures and standardized competence assessment in order to provide safe and high-quality interventions. We aimed to determine whether the involvement of trainees influences the outcome of the procedure and the incidence of ERCP-related adverse events.

Methods This was an international, multicenter, prospective, observational study conducted at six high- and low-volume centers across Europe between October 2016 and October 2018, and included independent operators and their trainees. Standard report forms documenting indication, trainee involvement, technical outcome, and complications over a 30-day follow-up of consecutive ERCP procedures were included in the analysis. Technical success of the procedure and procedure-related adverse events were compared between procedures in the trainee group and the control group using bivariable and multivariable analysis.

Results 21 trainees and 16 control endoscopists performed 1843 ERCPs during the study period. Trainee involvement in ERCP procedures did not decrease technical success (92.4 % vs. 93.7 %; P = 0.30) or increase the risk of adverse events (14.7 % vs. 14.6 %; P > 0.99). Conversely, there were significantly more moderate or severe adverse events in the control group compared with the trainee group (6.2 % vs. 3.4 %, P = 0.01). On multivariable analysis, only increased bilirubin levels, time to cannulation, and procedure difficulty level increased the risk of any procedure-related adverse event.

Conclusion Trainee involvement in ERCP interventions within a proper teaching setting is safe and does not compromise the success of the procedure.