Original article
Clinical endoscopy
Individual and practice differences among physicians who perform ERCP at varying frequency: a national survey

A modified version of these data was submitted for presentation to the annual meeting of the American Society of Gastrointestinal Endoscopy, Digestive Diseases Week 2011, Chicago, Illinois.
https://doi.org/10.1016/j.gie.2011.01.072Get rights and content

Background

ERCP practice patterns in the United States are largely unknown.

Objective

To characterize the ERCP practice of U.S. gastroenterologists, stratified by their annual case volume: high volume (HV, >200), moderate volume (MV, 50-200), and low volume (LV, <50).

Design

Anonymous electronic survey.

Subjects

American Society for Gastrointestinal Endoscopy members who are practicing U.S. gastroenterologists.

Results

Among all responders (N = 1006), 63% were derived from community practices. Physicians who performed ERCPs and provided data on annual volume (n = 669) were classified as LV (n = 254), MV (n = 284), and HV (n = 131). During training, 77% of LV physicians did not complete 180 ERCPs compared with 58% of MV and 34% of HV physicians (P < .0001). Only 58% of LV physicians enjoy performing ERCP compared with 88% of MV and 98% of HV physicians (P < .0001); 60% reported being “very comfortable” with ERCP compared with more than 90% of MV and HV physicians (P < .0001). LV physicians are less comfortable with pancreatic duct stenting (PDS) (57% vs 92% [MV] and 98% [HV], P ≤ .02) and using prophylactic PDS. Although HV physicians (42%) were least likely to use short-wire devices (P < .02), use of wire-guided cannulation was similar (74% LV, 72% MV, 66% HV, P = .13). Thirty-seven percent of LV physicians reported comfort with needle-knife sphincterotomy compared with 75% (MV) and 99% (HV) (P < .0001).

Limitations

Survey completion rate of 18.5%.

Conclusions

Self-reported comfort and/or enjoyment with ERCP is lower among LV physicians. Wire-guided cannulation is used by the majority of all ERCP practitioners, but prophylactic PDS is less frequently used by LV physicians. Because many LV physicians perform ERCP for higher-grade indications and use advanced techniques (eg, needle-knife sphincterotomy), further LV physician ERCP outcomes data are needed.

Section snippets

Methods

We conducted an online survey of U.S. gastroenterologists who are active members of the ASGE with registered e-mail addresses. Physicians were sent a direct Web link to the online survey instrument (SurveyMonkey, Palo Alto, Calif) via e-mail. Physicians were excluded if they were nongastroenterologists or did not complete the survey after 2 separate e-mail contacts. All answers remained anonymous to minimize the potential for response bias. Informed consent was implied by the subject's

Results

We contacted 5429 physicians, 1006 of whom (18.5%) completed all (n = 878) or part (n = 128) of the survey. We excluded 28 responders who identified themselves as nongastroenterologists. The majority (94.7%) of physicians reported having ERCP available in their practice, whereas only 76.9% performed ERCP themselves. Responding physicians derived from varying practice types: 50.2% from practices in which more than 200 ERCPs are performed each year and an additional 22.4% between 100 and 200. By

Importance of ERCP volume on outcomes

In North America and Europe, a large number of ERCPs are performed in relatively low volume centers and by endoscopists who perform fewer than 50 sphincterotomies each year.4, 12, 18, 19 A cohort study from Canada noted 40% of endoscopists perform fewer than 50 sphincterotomies each year.12 There are limited data on cannulation and intervention success rates specifically among lower-volume practitioners.20, 21, 22 Still, low endoscopist and hospital volume in ERCP is associated with a higher

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    DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Dr. Coté: consultant to Boston Scientific; Dr. McHenry: consultant to Boston Scientific; Dr. Sherman: consultant to Boston Scientific. The other authors disclosed no financial relationships relevant to this publication.

    If you would like to chat with an author of this article, you may contact Dr Coté at [email protected].

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    Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.