Endoscopy 2020; 52(S 01): S223-S224
DOI: 10.1055/s-0040-1704698
ESGE Days 2020 ePoster Podium presentations
Thursday, April 23, 2020 15:00 – 15:30 Quality and safety of GI- endoscopy ePoster Podium 4
© Georg Thieme Verlag KG Stuttgart · New York

GETTING THE JOB DONE: HOW TRAINEE INVOLVEMENT AFFECTS ERCP PROCEDURES – RESULTS FROM A PROSPECTIVE MULTICENTER OBSERVATIONAL TRIAL

T Voiosu
1   Colentina Clinical Hospital, Gastroenterology, Bucharest, Romania
2   Carol Davila School of Medicine, Internal Medicine, Bucharest, Romania
,
I 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
,
A Ladic
5   University Hospital Center, Zagreb, Croatia
,
A Voiosu
1   Colentina Clinical Hospital, Gastroenterology, Bucharest, Romania
,
A Benguș
1   Colentina Clinical Hospital, Gastroenterology, Bucharest, Romania
,
Ivo Klarin
6   Zadar General Hospital, Gastroenterology, Zadar, Croatia
,
V Bove
3   Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
,
B Smarandache
7   Cantacuzino Clinical Hospital, Bucharest, Romania
,
B Busuioc
7   Cantacuzino Clinical Hospital, Bucharest, Romania
,
N Rustemovic
5   University Hospital Center, Zagreb, Croatia
,
I Jovanovic
8   Clinic for Gastroenterology and Hepatology, `University of Belgrade Medical School, Belgrade, Serbia
,
B Mateescu
1   Colentina Clinical Hospital, Gastroenterology, Bucharest, Romania
2   Carol Davila School of Medicine, Internal Medicine, Bucharest, Romania
,
G 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

Publication Date:
23 April 2020 (online)

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Aims The impact of trainee involvement on the outcome of complex endoscopic procedures such as ERCP remains unclear. We aimed to evaluate the degree of trainee involvement in the real-life practice of ERCP procedures in a teaching setting.

Methods We conducted a post-hoc subgroup analysis of data from a large international multicenter trial evaluating the impact of trainee involvement on procedure outcomes at ERCP. Data about the indication of the procedure, papilla anatomy, trainee involvement and procedure-related outcomes were retrieved from the database and analyzed using SPSS.

Results Twenty-one trainees from 6 European endoscopy centers were involved in 822 ERCP procedures (44.6% of all procedures in the study), including 565 native papilla cases. The most common indication was common bile duct stones (47%), followed by malignant strictures of the CBD (32.1%). Most procedures were graded as grade I according to the Schutz scale (81.7%). Overall, technical success was achieved in 92.5% of the cases and there were 121 (14.7%) adverse events. Trainees managed to complete 58.4% of the procedures without supervisor assistance, requiring variable degree of hands-on assistance in an additional 21.6% of the. In 20% of the cases, trainees were unable to cannulate the desired duct. Failure of the trainee to cannulate the desired duct was associated with a significant increase in the use of precut technique by the supervising endoscopist (35.8% vs. 11.7%, p < 0.001) and an increase in the rate of procedure-related adverse events (38.8% vs. 8.9%, p < 0.001).

Conclusions ERCP procedures in a teaching setting can be successfully carried out by trainees without any hands-on assistance in a significant percentage of the cases. However, cannulation of the desired duct remains the critical point of the procedure, with failed cannulation by the trainee leading to an increase in the need for precut techniques and an increase in procedure-related adverse events.