THE NATIONAL PERFORMANCE IN THE MANAGEMENT OF COMMON BILE DUCT STONES IN ENGLAND

Aims Common Bile Duct Stones (CBDS) is a common indication for ERCP. There are British Society of Gastroenterology endorsed national standards for clearance rates with the expectation that 75% or more of initial ERCPs for CBDS should result in stone clearance(1). This paper will examine the NHS data set from all trusts in England to assess the treatment of CBDS.

Methods Using ICD-10 codes defined by an accredited clinical coder we examined the Hospital Episode Statistics (HES) data from England from 2013/4 to 2018/9 and selected those who had their initial bile duct stones presentations in 2015/6 to 2016/7. We followed this cohort of patients throughout the period of time from their presentation to the end of 2019 financial year and assessed how many ERCPs each patient underwent. We therefore had 2 years of patients with a primary diagnosis of bile duct stones with at least 2 years of follow up. All data is limited to NHS hospitals.

Results Over the 4 year follow up period 86,602 of the 183,503 ERCPs (47.2%) done were for CBDS. Within the 2015/6 to 2016/7 cohort was made of 37,468 patients who needed 55,556 ERCPs. 26,146 had only 1 ERCP, which, at best, represents a CBDS clearance rate at first ERCP of 69.8%. In addition, the remaining 11,322 (30.2%) patients required 29,410 ERCPs, demonstrating that 52.9% of ERCPs undertaken for those who had an initial CBDS presentation between 2015/16 and 2016/17 were repeat procedures. There is a is significant regional as well as trust variation in those needing more than 1 ERCP for CBDS.

Conclusions We are falling below the minimum standards required for stone clearance at ERCP, leading to findings that more than 50% of ERCPS for CBDS are repeat procedures. The reasons for this require further study, but the burden of cost is significant