Is Therapeutic Endoscopic Retrograde Cholangiopancreatography Safe and Effective During Live Demonstrations?-A Large Multi-Center Study from China

Abstract

Background and Objective: Live demonstrations of endoscopic retrograde cholangiopancreatography (ERCP) have a high educational value and contribute significantly to endoscopy development and training. It has been suggested that the pressure for endoscopists to succeed during live demonstrations might lead to lower success rate and higher complication rate. We report a multi-center retrospective analysis to evaluate the success rate and complications of therapeutic ERCP among patients participated in live demonstrations in China. Patients and Methods All patients who underwent therapeutic ERCP during live demonstrations at gastrointestinal endoscopy conferences in China between January 2002 and December 2006 were included. The matched control for each patient was the patient admitted to the same ERCP unit with similar indications, which received ERCP by endoscopists with similar experience as those who performed live demonstrations. Clinical and endoscopic characteristics including age, gender, indication, therapeutic intervention, success rate, and complication were collected and compared with matched controls. Differences in ERCP outcomes between domestic and foreign experts were compared. Risk factors associated with complete failure and post-ERCP complications were analyzed. Results: Thirty-four conferences (386 patients) involving live ERCP demonstrations were held in 14 endoscopy centers. There were no significant differences in gender ratio, age, indication, and therapeutic intervention among live demonstration and controls. The therapy was less successful in live demonstrations than controls (94.0% vs. 97.4%, p = 0.0207). There was no statistically significant difference in overall complication rates among patients in live demonstrations and the controls (10.9% vs. 8.0%, p = 0.1761). ERCP performed by foreign endoscopists was as safe and successful as domestic ones. Multivariate analyses showed first-time demonstrators had more complete failures (OR 3.255, 95% CI: 2.3-8.4) and higher post-ERCP complications (OR 2.9, 95% CI: 1.3-6.3) as were demonstrations performed on the same day of arrival (OR 5.7, 95% CI: 1.5-21.8). Conclusion: The success rate of therapeutic ERCP performed during live demonstrations was lower than routine procedures, but the overall complication rate of ERCP was comparable to controls. Lack of prior performing experience during live demonstration accounted for a higher failure rate and increased complications.