3364 Asge guidelines on therapeutic ercp training: are they appropriate?

Abstract

Introduction: ASGE recommends one year of intensive therapeutic ERCP training for receiving previleges in an academic center. Aims: To examine the outcome of one year of advanced ERCP training on the technical success & complication rate of therapeutic ERCP by one endoscopist during the first year after graduation from advanced endoscopy fellowship training program. Methods & Results: ERCP Training: During 7/98-6/99, the trainee (GSR) participated in 697 ERCPs & shared the ERCP caseload with 4 GI fellows at the BIDMC. The trainee did 50% of the ERCP cases and also assisted in the training of the 3rd year GI fellows. The trainee was encouraged to do multiple stages of each procedure. If cannulation was unsuccessful, the mentor cannulated & gave the endoscope back to the trainee to complete the remaining procedure. Endoscopic sphincterotomy was taught early on & during the latter half of training, the trainee learned precut techniques. During the last quarter, the trainee completed 19 of 21 consecutive therapeutic ERCP cases successfully, without assistance from the mentor. First year after ERCP training: After joining KUMC as a therapeutic endoscopist(GSR) in 7/98, the outcome of consecutive ERCP cases done in first year by GSR was analyzed (n= 100). Classification of the ERCP cases according to the difficulty of the ERCP procedures ( Gastrointest endosc 1999;49:AB148 ): Group 1-Simple diagnostic ERCP: 22/24 (92%); Group 2-Simple therapeutic ERCP: 15/16 (94%) (biliary sphincterotomy, cbd stone ( 3) / large (>1cm) CBD stone removal, CBD stricture dilation, CBD stenting); Group 5-Ultracomplex therapeutic ERCP:13/17 (76%)(needle knife sphincteotomy, CBD stone lithotripsy+ stone removal, intrahepatic stone removal or stricture dilation, & all pancreatic therapy). Complications: pancreatitis: 8; bleeding: 0; perforation: 0; neck infection: 1; cardiac arrest: 1 (revived). Mortality: one patient died 48 hours after the procedure due to a CVA & aspiration. Conclusions: Dedicated therapeutic ERCP training for one year provides the necessary endoscopic skills to perform ERCP successfully with low complication rate. The outcome is comparable to the results published in the literature (Gastrointest endosc 1999;49:AB148). The ASGE guidelines on therapeutic ERCP training appear to be appropriate.