Endoscopy
DOI: 10.1055/a-2418-3540
Original article

Intra- and post-procedural patient-reported experience measures and their correlation with post-ERCP adverse events and unplanned healthcare utilization

1   Department of Medicine, University of Toronto, Toronto, Ontario, Canada
,
Mehul Gupta
2   Department of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Maximilian Eisele
3   Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Rishad Khan
4   Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
,
Jonathan Besney
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Howard Guo
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Getanshu Malik
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Catherine Tsai
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Arjun Kundra
6   Department of Gastroenterology and Hepatology, University of Virginia Medical Center, University of Virginia School of Medicine, Charlottesville, Virginia, United States
,
2   Department of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Angelica Rivas
2   Department of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Gurjot Minhas
 7   Division of Gastroenterology and Hepatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
,
Alejandra Tepox-Padrón
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Yousef Alshammari
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Millie Chau
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Megan Howarth
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Shane Cartwright
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Sara Ficcacio
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Hannah F. Koury
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Enrique de-Madaria
 8   Department of Gastroenterology, Dr. Balmis General University Hospital, Alicante, Spain
,
5   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
 9   Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
,
on behalf of the CReATE Working Group
› Author Affiliations
NB Hershfield Chair in Therapeutic Endoscopy, University of Calgary
Pentax Medical Canada


Abstract

Background Post-endoscopic retrograde cholangiopancreatography (ERCP) adverse events (AEs) are common, as is unplanned healthcare utilization (UHU). We aimed to assess potential etiologic associations between intra-/post-procedural patient-reported experience measures (PREMs) and post-ERCP AEs and UHU.

Methods Prospective data from a multicenter collaborative were used. A 0–10 Likert-based PREM assessing intra- and post-procedural symptoms was applied to patients following ERCP, and follow-up was performed at 30 days to identify AEs and UHU for reasons not meeting the definitions of any AE. Multivariable logistic regression was conducted using PREM domains as exposures and AEs and UHU as outcomes, with a priori selected covariates. Odds ratios (ORs) and 95 %CIs for each PREM domain were reported.

Results From 2018 to 2023, 3434 patients were included. A post-procedural abdominal pain score > 3 was associated with pancreatitis (OR 3.71 [95 %CI 2.37–5.73]), while a score > 6 was associated with perforation (OR 9.54 [95 %CI 1.10–59.37]). Post-procedural pain was also associated with UHU within 30 days when used as a continuous exposure (OR 1.08 per point [95 %CI 1.01–1.16]), and when partitioned at a score > 3 (OR 1.79 [95 %CI 1.13–2.74]) and a score > 6 (OR 1.93 [95 %CI 1.02–3.46]). No other intra- or post-procedural PREMs were associated with any AEs or UHU.

Conclusions Patient-reported abdominal pain from a Likert-based PREM at the time of discharge from ERCP was associated with pancreatitis, perforation, and UHU within 30 days. Applying PREMs could potentially prevent UHU and/or facilitate earlier management and improved outcomes for patients with post-ERCP AEs.

Alessandra Ceccacci and Mehul Gupta contributed equally to this work.


Supplementary Material



Publication History

Received: 15 April 2024

Accepted after revision: 19 September 2024

Accepted Manuscript online:
19 September 2024

Article published online:
06 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Carr-Locke DL. Overview of the role of ERCP in the management of diseases of the biliary tract and the pancreas. Gastrointest Endosc 2002; 56 (06) S157-160
  • 2 Dumonceau JM, Kapral C, Aabakken L. et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2020; 52: 127-149
  • 3 Chandrasekhara V, Khashab MA, Muthusamy VR. et al. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85: 32-47
  • 4 Akshintala VS, Kanthasamy K, Bhullar FA. et al. Incidence, severity, and mortality of post-ERCP pancreatitis: an updated systematic review and meta-analysis of 145 randomized controlled trials. Gastrointest Endosc 2023; 98: 1-6.e12
  • 5 Huang RJ, Barakat MT, Girotra M. et al. Unplanned hospital encounters after endoscopic retrograde cholangiopancreatography in 3 large North American States. Gastroenterology 2019; 156: 119-129.e113
  • 6 Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 2013; 3: e001570
  • 7 Telford J, Tavakoli I, Takach O. et al. Validation of the St. Paul’s Endoscopy Comfort Scale (SPECS) for colonoscopy. J Can Assoc Gastroenterol 2020; 3: 91-95
  • 8 Munson GW, Van Norstrand MD, O’Donnell JJ. et al. Intraprocedural evaluation of comfort for sedated outpatient upper endoscopy and colonoscopy: the La Crosse (WI) intra-endoscopy sedation comfort score. Gastroenterol Nurs 2011; 34: 296-301
  • 9 Rostom A, Ross ED, Dube C. et al. Development and validation of a nurse-assessed patient comfort score for colonoscopy. Gastrointest Endosc 2013; 77: 255-261
  • 10 Forbes N, Chau M, Koury HF. et al. Development and validation of a patient-reported scale for tolerability of endoscopic procedures using conscious sedation. Gastrointest Endosc 2021; 94: 103-110.e102
  • 11 Chow A, Mayer EK, Darzi AW. et al. Patient-reported outcome measures: the importance of patient satisfaction in surgery. Surgery 2009; 146: 435-443
  • 12 Soler-Michel P, Courtial I, Bremond A. Reattendance of women for breast cancer screening programs. A review. [Article in French]. Rev Epidemiol Sante Publique 2005; 53: 549-567
  • 13 Fullam F, Garman AN, Johnson TJ. et al. The use of patient satisfaction surveys and alternative coding procedures to predict malpractice risk. Med Care 2009; 47: 553-559
  • 14 Knutsson B, Kadum B, Eneqvist T. et al. Patient satisfaction with care is associated with better outcomes in function and pain 1 year after lumbar spine surgery. J Patient Cent Res Rev 2022; 9: 7-14
  • 15 Coelho-Prabhu N, Forbes N, Thosani NC. et al. Adverse events associated with EGD and EGD-related techniques. Gastrointest Endosc 2022; 96: 389-401.e381
  • 16 Kothari ST, Huang RJ, Shaukat A. et al. ASGE review of adverse events in colonoscopy. Gastrointest Endosc 2019; 90: 863-876.e833
  • 17 Forbes N, Coelho-Prabhu N, Al-Haddad MA. et al. Adverse events associated with EUS and EUS-guided procedures. Gastrointest Endosc 2022; 95: 16-26.e12
  • 18 Forbes N, Koury HF, Bass S. et al. Characteristics and outcomes of ERCP at a Canadian tertiary centre: initial results from a prospective high-fidelity biliary endoscopy registry. J Can Assoc Gastroenterol 2021; 4: 78-83
  • 19 Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49: 924-934
  • 20 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
  • 21 Forbes N, Elmunzer BJ, Keswani RN. et al. Consensus-based development of a causal attribution system for post-ERCP adverse events. Gut 2022; DOI: 10.1136/gutjnl-2022-328059.
  • 22 Thiruvengadam NR, Kouanda A, Kalluri A. et al. A prospective cohort study evaluating PAN-PROMISE, a patient-reported outcome measure to detect post-ERCP morbidity. Clin Gastroenterol Hepatol 2023; 21: 1233-1242.e1214
  • 23 Dolan P. Modeling valuations for EuroQol health states. Med Care 1997; 35: 1095-1108
  • 24 Jeurnink SM, Steyerberg E, Kuipers E. et al. The burden of endoscopic retrograde cholangiopancreatography (ERCP) performed with the patient under conscious sedation. Surg Endosc 2012; 26: 2213-2219
  • 25 de-Madaria E, Buxbaum JL, Maisonneuve P. et al. Aggressive or moderate fluid resuscitation in acute pancreatitis. New Engl J Med 2022; 387: 989-1000
  • 26 Sommer JL, Reynolds K, Hebbard P. et al. Healthcare-related correlates of preoperative psychological distress among a mixed surgical and cancer-specific sample. J Psychosom Res 2022; 162: 111036
  • 27 Buxbaum JL, Freeman M, Amateau SK. et al. American Society for Gastrointestinal Endoscopy guideline on post-ERCP pancreatitis prevention strategies: methodology and review of evidence. Gastrointest Endosc 2023; 97: 163-183.e140
  • 28 Buxbaum JL, Freeman M, Amateau SK. et al. American Society for Gastrointestinal Endoscopy guideline on post-ERCP pancreatitis prevention strategies: summary and recommendations. Gastrointest Endosc 2023; 97: 153-162
  • 29 Elmunzer BJ, Foster LD, Serrano J. et al. Indomethacin with or without prophylactic pancreatic stent placement to prevent pancreatitis after ERCP: a randomised non-inferiority trial. Lancet 2024; 403: 450-458
  • 30 Elmunzer BJ, Scheiman JM, Lehman GA. et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. New Engl J Med 2012; 366: 1414-1422
  • 31 Smith ZL, Elmunzer BJ, Cooper GS. et al. Real-world practice patterns in the era of rectal indomethacin for prophylaxis against post-ERCP pancreatitis in a high-risk cohort. Am J Gastroenterol 2020; 115: 934-940
  • 32 Avila P, Holmes I, Kouanda A. et al. Practice patterns of post-ERCP pancreatitis prophylaxis techniques in the United States: a survey of advanced endoscopists. Gastrointest Endosc 2020; 91: 568-573.e562