Category Archives: Retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography usage (Part 3)

liver transplant programOne of these has a large liver transplant program. The other has centralized all its ERCPs into a single regional therapeutic endoscopy unit where a small number of endoscopists perform a large number of ERCPs. The other two regions are composed of small cities and large rural areas. Clearly, the mix of patients in each of these regions will be quite different and each region’s therapeutic rate may be the correct one for its population. To confirm this would require reviewing the indications for each ERCP to determine whether the ERCP was appropriate. However, appropriateness criteria that are available for other endoscopic procedures are not available for ERCP.

Endoscopic retrograde cholangiopancreatography usage (Part 2)

Although it is widely accepted that ERCP should be primarily a therapeutic procedure, there is no consensus on what proportion of procedures should be therapeutic versus diagnostic. Certainly this will depend on the patient mix seen by an endoscopist and the availability of other diagnostic and therapeutic expertise available within a given region. It is recommended that ERCP training programs have therapeutics involved in over 50% of cases .

Endoscopic retrograde cholangiopancreatography usage (Part 1)

post-ERCP pancreatitisIt should be noted that many of the available measures of regional variation can be misleading when used to compare rate variations reported by different studies, especially if the population sizes of the studies are quite different or if events can occur more than once in a given patient. Over the years examined, 18 to 20 endoscopists were performing ERCPs each year. Maintenance of ERCP competence requires ongoing use of acquired skills. Previously, it was estimated that 50 ERCPs/year were required.