Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(02): E142-E148
DOI: 10.1055/a-1951-4421
Original article

ERCP for bile duct stones across a national service, demonstrating a high requirement for repeat procedures

Harry Martin
1   Pancreatobiliary Medicine, University College London Hospitals, London, UK
,
Richard Sturgess
2   Department of Gastroenterology Liverpool University NHS trust
,
Neil Mason
3   Methods Analytics, London, UK
,
Adam Ceney
3   Methods Analytics, London, UK
,
Jodi Carter
3   Methods Analytics, London, UK
,
Lilith Barca
3   Methods Analytics, London, UK
,
James Holland
3   Methods Analytics, London, UK
,
Simon Swift
3   Methods Analytics, London, UK
4   University of Exeter Business School INDEX unit, Exeter, UK
,
George J. Webster
1   Pancreatobiliary Medicine, University College London Hospitals, London, UK
› Author Affiliationshttp://dx.doi.org/10.13039/100008497
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Bile duct stones (BDS) represent approximately 50 % of the requirement for endoscopic retrograde cholangiopancreatography (ERCP) within most services. Significant variation in outcome rates for BDS clearance at ERCP has been reported, and endoscopy societies have set standards for expected clearance rates. The aim of this study was to analyze procedure outcomes across a national service.

Patients and methods Using verified hospital episode statistics (HES) data for the National Health Service (NHS) in England, we analyzed all patients having first ERCPs for BDS from 2015 to 2017, and followed these patients for at least 2 years.

Results In total 37,468 patients underwent a first ERCP for BDS, with 69.8 % undergoing only one procedure. This figure of less than 70 % of BDS cleared at first ERCP is below the Key Performance Indicators as set by the British Society of Gastroenterology (> 75 %) and the European Society of Gastrointestinal Endoscopy (> 90 %). Of 55,556 ERCPs done for BDS, 52.9 % were repeat procedures, with 11,322 patients needing multiple procedures. For hospitals performing significant numbers of ERCPs (more than 600 for BDS during the study period) patients undergoing repeat ERCPs for BDS ranged from 9 % to 50 %.

Conclusions In this nationwide study, the performance at clearing BDS at first ERCP was suboptimal, with high numbers of repeat procedures required. This may have a negative impact on both patient outcomes and experience, and increase pressure on endoscopy services. Apparent variation of outcome between acute hospital care providers requires further analysis.

Supplementary material



Publication History

Received: 21 April 2022

Accepted after revision: 26 September 2022

Accepted Manuscript online:
27 September 2022

Article published online:
02 February 2023

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Manes G, Paspatis G, Aabakken L. et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2019; 51: 472-491
    Google Scholar
  • 2 Collins C, Maguire D, Ireland A. et al. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 2004; 239: 28-33
    CrossrefPubMedGoogle Scholar
  • 3 Caddy GR, Kirby J, Kirk SJ. et al. Natural history of asymptomatic bile duct stones at time of cholecystectomy. Ulster Med J 2005; 74: 108-112
    PubMedGoogle Scholar
  • 4 Möller M, Gustafsson U, Rasmussen F. et al. Natural course vs interventions to clear common bile duct stones: data from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). JAMA Surg 2014; 149: 1008
    CrossrefPubMedGoogle Scholar
  • 5 Williams EJ, Taylor S, Fairclough P. et al. Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice. Gut 2007; 56: 821-829
    CrossrefPubMedGoogle Scholar
  • 6 Bodger K, Bowering K, Sarkar S. et al. All-cause mortality after first ERCP in England: clinically guided analysis of hospital episode statistics with linkage to registry of death. Gastrointest Endosc 2011; 74: 825-833
    CrossrefPubMedGoogle Scholar
  • 7 Cotton PB, Romagnuolo J, Faigel DO. et al. The ERCP Quality Network: A Pilot Study of Benchmarking Practice and Performance. Am J Med Qual 2013; 28: 256-260
    CrossrefPubMedGoogle Scholar
  • 8 Ekkelenkamp VE, de Man RA, Ter Borg F. et al. Prospective evaluation of ERCP performance: results of a nationwide quality registry. Endoscopy 2015; 47: 503-507
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Wilkinson M, Charmley R, Morris J. et al. ERCP – The way forward, a standards framework. https://www.bsg.org.uk/resource/ercp---the-way-forward--a-standards-framework-pdf.html
    PubMedGoogle Scholar
  • 10 Adler DG, Lieb JG, Cohen J. et al. Quality Indicators for ERCP. Am J Gastroenterol 2015; 110: 91-101
    CrossrefPubMedGoogle Scholar
  • 11 Enochsson L, Swahn F, Arnelo U. et al. Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP. Gastrointest Endosc 2010; 72: 1175-1184.e3
    CrossrefPubMedGoogle Scholar
  • 12 Glomsaker T, Hoff G, Kvaløy JT. et al. Patterns and predictive factors of complications after endoscopic retrograde cholangiopancreatography. Br J Surg 2013; 100: 373-380
    CrossrefPubMedGoogle Scholar
  • 13 Coelho-Prabhu N, Shah ND, Van Houten H. et al. Endoscopic retrograde cholangiopancreatography: utilisation and outcomes in a 10-year population-based cohort. BMJ Open 2013; 3: e002689
    CrossrefPubMedGoogle Scholar
  • 14 Coté GA, Imler TD, Xu H. et al. Lower provider volume is associated with higher failure rates for endoscopic retrograde cholangiopancreatography. Med Care 2013; 51: 1040-1047
    CrossrefPubMedGoogle Scholar
  • 15 Freeman ML, Nelson DB, Sherman S. et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335: 909-919
    CrossrefPubMedGoogle Scholar
  • 16 Loperfido S, Angelini G, Benedetti G. et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 1998; 48: 1-10
    CrossrefPubMedGoogle Scholar
  • 17 Andriulli A, Loperfido S, Napolitano G. et al. Incidence rates of Post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007; 102: 1781-1788
    CrossrefPubMedGoogle Scholar
  • 18 Bergman JJ, Rauws EA, Tijssen JG. et al. Biliary endoprostheses in elderly patients with endoscopically irretrievable common bile duct stones: report on 117 patients. Gastrointest Endosc 1995; 42: 195-201
    CrossrefPubMedGoogle Scholar
  • 19 Chopra KB, Peters RA, O’Toole PA. et al. Randomised study of endoscopic biliary endoprosthesis versus duct clearance for bileduct stones in high-risk patients. Lancet Lond Engl 1996; 348: 791-793
    CrossrefPubMedGoogle Scholar
  • 20 Spiegelhalter DJ. Funnel plots for comparing institutional performance. Stat Med 2005; 24: 1185-1202
    CrossrefPubMedGoogle Scholar
  • 21 Williams E, Beckingham I, El Sayed G. et al. Updated guideline on the management of common bile duct stones (CBDS). Gut 2017; 66: 765-782
    CrossrefPubMedGoogle Scholar
  • 22 Oppong KW, Romagnuolo J, Cotton PB. The ERCP quality network benchmarking project: a preliminary comparison of practice in UK and USA. Frontline Gastroenterol 2012; 3: 157-161
    CrossrefPubMedGoogle Scholar
  • 23 Keswani RN, Qumseya BJ, O’Dwyer LC. et al. Association between endoscopist and center endoscopic retrograde cholangiopancreatography volume with procedure success and adverse outcomes: a systematic review and meta-analysis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2017; 15: 1866-1875.e3
    PubMedGoogle Scholar
  • 24 Kim KH, Kim TN. Efficacy and safety of endoscopic papillary large balloon dilation for removal of large bile duct stones in advanced age. Can J Gastroenterol Hepatol 2016; 2016: 6568989
    PubMedGoogle Scholar
  • 25 Brewer Gutierrez OI, Bekkali NLH, Raijman I. et al. Efficacy and safety of digital single-operator cholangioscopy for difficult biliary stones. Clin Gastroenterol Hepatol 2018; 16: 918-926.e1
    Google Scholar
  • 26 Usküdar O, Parlak E, Dişibeyaz S. et al. Major predictors for difficult common bile duct stone. Turk J Gastroenterol Off J Turk Soc Gastroenterol 2013; 24: 260-265
    PubMedGoogle Scholar
  • 27 Almadi M, Eltayeb M, Thaniah S. et al. Predictors of failure of endoscopic retrograde cholangiography in clearing bile duct stone on the initial procedure. Saudi J Gastroenterol 2019; 25: 132
    CrossrefPubMedGoogle Scholar
  • 28 Garg PK, Tandon RK, Ahuja V. et al. Predictors of unsuccessful mechanical lithotripsy and endoscopic clearance of large bile duct stones. Gastrointest Endosc 2004; 59: 601-605
    CrossrefPubMedGoogle Scholar
  • 29 Burns EM, Rigby E, Mamidanna R. et al. Systematic review of discharge coding accuracy. J Public Health 2012; 34: 138-148
    CrossrefPubMedGoogle Scholar
  • 30 Campbell SE, Campbell MK, Grimshaw JM. et al. A systematic review of discharge coding accuracy. J Public Health 2001; 23: 205-211
    CrossrefPubMedGoogle Scholar
  • 31 Wright FL, Green J, Canoy D. et al. Vascular disease in women: comparison of diagnoses in hospital episode statistics and general practice records in England. BMC Med Res Methodol 2012; 12: 161
    CrossrefPubMedGoogle Scholar
  • 32 Davis KAS, Bashford O, Jewell A. Beiki O. et al. Using data linkage to electronic patient records to assess the validity of selected mental health diagnoses in English Hospital Episode Statistics (HES). PLoS ONE 2018; 13: e0195002
    CrossrefPubMedGoogle Scholar