TRAINEE PERFORMANCE IS CORRELATED WITH THE RISK OF PROCEDURE-RELATED ADVERSE EVENTS DURING HANDS-ON TRAINING ERCPS: RESULTS FROM THE INTERNATIONAL MULTICENTER TIERS STUDY

Aims Operator skill is a recognized risk factor for procedure related adverse events (AE) at ERCP. We aimed to study whether trainee technical performance as assessed by a validated instrument such as the TEESAT score can influence ERCP AE rates.

Methods We analyzed data from a prospective, multicenter, observational study (the TIERS study) in 5 European endoscopy training centers. Data on consecutive ERCP procedures with any degree of hands on trainee involvement was collected using standardized forms, including the overall TEESAT score attributed by the trainer to grade the technical performance of the trainee. Patients were followed for 30 days after the procedure 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 of the procedure, postERCP pancreatitis, bleeding, perforation, death or prolonged hospital stay. Multivariable analysis was conducted using SPSS.

Results A total of 409 consecutive ERCPs performed by 10 trainees and 11 supervisors between September 2019 – September 2021 were included in our analysis. In a logistic regression model including the TEESAT score, patient age, gender, bilirubin levels, indication for ERCP, difficult cannulation, use of precut, level of procedure difficulty and previous technical failure, the TEESAT score was shown to be the strongest predictor of any AE occuring after a training ERCP (p=0.044, OR 0.39, CI 95% 0.16-0.97), with difficult cannulation being the only other independent risk factor.

Conclusions Our findings suggest that trainee performance is correlated with procedure-related AE rates, prompting further research into this important field.

Publication History

Article published online:
14 April 2022