ERCP: a review of technical competency and workload in a small unit

Area of Science:

• Gastroenterology
• Endoscopy
• Medical Quality Improvement

Background:

• Endoscopic Retrograde Cholangiopancreatography (ERCP) is now performed in various healthcare settings, including smaller hospitals.
• Analysis of ERCP performance in a small unit is crucial for understanding workload and success rates.

Purpose of the Study:

• To analyze the success rates of selective cannulation and intervention during ERCP using the cumulative sum method.
• To document the workload and assess performance in a small hospital unit.

Main Methods:

• One endoscopist recorded indications, results, and interventions for all ERCP procedures over 8 years.
• Success rates for selective cannulation and intervention were measured and compared to a 90% target using the cumulative sum method.

Main Results:

• Over 532 ERCPs, 91% selective cannulation and 81% successful interventions were achieved.
• Cumulative sum analysis indicated satisfactory outcomes for cannulation around 100-120 procedures and for interventions around 120 procedures.
• Common findings included normal ERCP (32%), stones (32%), and strictures (15%).

Conclusions:

• The cumulative sum method effectively compares individual performance against targets, ensuring maintained quality.
• Small units can develop and sustain ERCP expertise through regular procedure volume.