The ERCP quality network benchmarking project: a preliminary comparison of practice in UK and USA
- 1Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle, UK
- 2Digestive Disease Center, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
- Correspondence to Dr Kofi W Oppong, Hepato-Pancreato-Biliary Unit, Level 6, Freeman Hospital, High Heaton, Newcastle upon Tyne, Newcastle, NE7 7DN, UK;
Contributors The ERCP QN was initiated by PBC. PBC and KWO designed the study. Statistical analysis was carried out by JR. KWO wrote the manuscript. All authors contributed to the drafting process and have seen and approved the final version.
- Received 14 December 2011
- Accepted 13 March 2012
- Published Online First 1 May 2012
Objective The Endoscopic retrograde cholangiopancreatography (ERCP) Quality Network is a voluntary system for submission of data to generate individual report cards and benchmarking. The aim of this study was to compare aspects of ERCP practice between USA and UK participants.
Design Analysis was limited to USA and UK based endoscopists who had each entered more than 30 cases. A number of practice and performance measures were studied including, rates of deep biliary cannulation, sedation use and success in bile duct stone removal.
Setting and patients Patients attending for routine and emergency ERCP in participating tertiary and secondary care units in the UK and USA.
Results 61 US endoscopists performed 18 182 procedures and 16 UK endoscopists 3172, respectively. The UK participants performed less complex procedures as judged by the accepted complexity grading system, 8% versus 35% at grade 3, p<0.001. There was a significantly greater use of sedation as opposed to anaesthesia in the UK 97% versus 34%, p<0.001. UK deep biliary cannulation rate was 93% versus 97%, p<0.001. For small bile duct stones (<10 mm) the UK success rate was 96% compared with 99%, p<0.001.
Conclusion The present data, while not purporting to be an accurate representation of practice in either country, documents good technical success in both cohorts, albeit significantly better in the USA. The inexorable drive to greater accountability and transparency of outcomes in endoscopic practice is likely to lead to increased participation in subsequent benchmarking projects.
Funding This study was supported by the Olympus Corporation of America.
Competing interests PBC and JR have undertaken consultancy work for the Olympus Corporation of America.
Ethics approval The study was approved by the institutional review board of the Medical University of South Carolina.
Provenance and peer review Not commissioned; externally peer reviewed.