Evaluation of endoscopic retrograde cholangiopancreatography procedures performed in general hospitals in France

Abstract

Evaluate endoscopic retrograde cholangiopancreatography (ERCP) in general hospitals in France. Prospective study of ERCP procedures performed in 28 centers during an 18-month period. Success was assessed at day 1; morbidity and mortality were assessed at 30 days. 2708 ERCP procedures were performed in 28 centers. The rate of success was 92.1% and was higher among centers performing more than 200 procedures annually (OR 2.07 [1.522.86]). Therapeutic success was correlated with diameter of the common bile duct>6 mm (OR 9.1 [7.15-11.57]) and center activity level (OR 1.91 [1.38-2.6]). The rate of complications and deaths were 9.1% and 4%; procedure-specific mortality was 0.8%. Morbidity was lower in centers performing more than 200 procedures annually (OR 0.36 [0.22-0.6]) and when the operator considered the procedure easy to perform (OR 0.5 [0.35-0.74]). Mortality was correlated with ASA score (OR for patients with ASA scores 2, 3, 4 were 9 [1-66], 53.3 [7.3-392] and 164.7 [21.71249]) respectively, occurrence of a complication (OR=3.9 [1.96-7.78]), diameter of the common bile duct, and technical success (OR=0.49 [0.27-0.88]). This study shows that success of ERCP and post-ERCP morbidity are related to center activity level while post-ERCP mortality is strongly linked with the patient's ASA score.