Endoscopic retrograde cholangiopancreatography (ERCP) has become a predominantly therapeutic intervention with a resultant increase in complexity. The relationship between ERCP volume and outcomes is unclear.
Dr Rajesh Keswani and colleagues conducted a systematic review and meta-analysis assessing the relationship between endoscopist and center ERCP volume with ERCP success and adverse event rates.
A comprehensive search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted from inception to 2017.
Studies providing outcomes stratified by endoscopist and/or center volume were included in the final analysis.
|13 articles met inclusion criteria|
|Clinical Gastroenterology & Hepatology|
The research team stratified endoscopist/center volume as low volume and high volume.
The team report that the definition of ERCP success varied between studies.
The overall AE rate was a composite rate including pancreatitis, perforation, and bleeding.
The researchers identified 1264 citations.
Of those, 13 articles met inclusion criteria.
The researchers found that low volume endoscopist, and center definitions varied between studies.
The team found that high volume endoscopists were significantly more likely to achieve ERCP success compared with low volume endoscopists.
The researchers noted that high volume centers were significantly more likely to achieve ERCP success.
The post-ERCP adverse event risk was lower for high volume endoscopists but not high volume centers.
Dr Keswani's team concludes, "This study identifies a significant relationship between increasing endoscopist and center ERCP volume with overall procedure success."
"Increasing endoscopist volume also was associated with a decreased adverse event rate."
"Given these compelling findings, we propose that providers and payers consider consolidating ERCP to high volume endoscopists to improve ERCP outcomes and value."