Endoscopy 2018; 50(04): S126
DOI: 10.1055/s-0038-1637406
ESGE Days 2018 ePoster Podium presentations
21.04.2018 – Training and education
Georg Thieme Verlag KG Stuttgart · New York

IMPACT OF TRAINEE INVOLVEMENT ON CANNULATION TECHNIQUE AT ERCP: INTERIM ANALYSIS FROM A MULTICENTER OBSERVATIONAL STUDY

, Quality Assessment in ERCP (QUASIE) Study Group
T Voiosu
1   UMF Carol Davila School of Medicine, Internal Medicine Department, Bucharest, Romania
2   Colentina Clinical Hospital, Gastroenterology Division, Bucharest, Romania
,
A Ladic
3   UHC, Internal Medicine, Zagreb, Croatia
,
A Voiosu
2   Colentina Clinical Hospital, Gastroenterology Division, Bucharest, Romania
,
A Benguş
2   Colentina Clinical Hospital, Gastroenterology Division, Bucharest, Romania
,
A Gheorghe
2   Colentina Clinical Hospital, Gastroenterology Division, Bucharest, Romania
,
B Mateescu
1   UMF Carol Davila School of Medicine, Internal Medicine Department, Bucharest, Romania
2   Colentina Clinical Hospital, Gastroenterology Division, Bucharest, Romania
,
N Rustemovic
3   UHC, Internal Medicine, Zagreb, Croatia
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Despite advances in recent years we currently lack a formal algorithm for training endoscopists in ERCP and data regarding technical success and outcomes of procedures involving trainees is very limited. We aimed to analyze the impact of trainee involvement on the cannulation technique of the common bile duct.

Methods:

We conducted an interim analysis of data from a prospective observational study of ERCP procedures currently ongoing in two endoscopy training centers (Colentina Hospital, Bucharest and UHC, Zagreb). Data about the procedure (indication, cannulation technique, timing of cannulation, trainee involvement) as well as procedure outcome were prospectively collected using a standard form. Successful cannulation of the bile duct, cannulation technique and time to cannulation were compared between procedures where trainees were involved (TI) and those without trainee involvement (NTI).

Results:

Four hundred seventy-four consecutive ERCP procedures conducted in the two units were reviewed and 366 native papilla cases performed by 9 endoscopists (6 supervisors/3 trainees) were included in the final analysis. Trainees achieved a 63.2% cannulation rate and successfully completed 48% of their procedures without supervisor intervention. Cannulation rates were similar in the two groups (90.4% TI vs. 94.7% NTI, p = 0.44). Time to cannulation was significantly longer in the trainee group, with only 46.4% of cannulations under 5 minutes compared to 66.3% in the control group (p < 0.001). On multivariate analysis, initial failed cannulation by a trainee was the only risk factor for use of precut techniques (OR 4.5, 95% CI 1.7 – 11.7). No difference in the rate of adverse events between study groups was noted (TI 8% vs. NTI 12.4%, p = 0.22).

Conclusions:

Trainee involvement delays cannulation of the bile duct and increases the use of precut techniques without compromising technical success of the procedure or increasing the rate of complications.