A SIMPLE CLINICAL RISK SCORE CAN PREDICT PROCEDURE-RELATED ADVERSE EVENTS IN ERCPS WITH TRAINEE INVOLVEMENT: RESULTS FROM THE INTERNATIONAL MULTICENTER OBSERVATIONAL TIERS STUDY

Aims There are limited data assessing the impact of trainee involvement on ERCP effectiveness and safety. We aimed to validate a simple risk score ([Table 1]) that includes patient- and procedure-related variables designed to predict adverse events (AEs) in ERCPs with trainee involvement.

Table 1

Risk factor	Points attributed (a total score>1 is considered high risk for procedure-related adverse events for ERCPs with trainee involvement)
Native papilla	1 point
Bilirubin>10mg/dL	1 point
Schutz difficulty≥grade 2	2 points
Failure of a previous ERCP attempt	3 points

Methods We conducted a prospective, multicenter, observational study in 5 European training centers evaluating the accuracy of our proposed risk score. Data on consecutive ERCP procedures with trainee involvement was collected using standard forms. Patients were followed for 30 days to accurately assess outcomes and AEs. The primary outcome measure was the rate of procedure-related AE which included any of the following: technical failure, postERCP pancreatitis, bleeding, perforation, death or prolonged hospital stay.

Results Between September 2019 and September 2021 we enrolled 409 ERCP procedures (72% with native papilla) performed by 11 supervisors and 10 trainees. There were 86 (21.2%) AEs in our cohort, with a 30-day mortality rate of 0.7%. There was a significant difference in AE rates (17.1% vs. 27%, p=0.002) and technical success rates (93.1% vs 79.9%, p<0.001) between high and low-risk procedures. Our score showed a high negative predictive value of 82.9% for AEs. On multivariable analysis, after adjusting for gender, age and indication for ERCP, the risk score was the only predictor of AE, with an OR of 1.38 for each additional risk point (p=0.006).

Conclusions The TIERS risk model performed well in a real-life setting and could personalize ERCP training by allowing novice endoscopists to start training in selected, low-risk cases, thus increasing patient safety.

Publication History

Article published online:
14 April 2022