Success Rate and Complications of ERCP Performed During Hands-On Training Courses: A Multicenter Study in China

Abstract

Background and Objective: Hands-on endoscopy workshops are popular and valuable sources for the continuing medical education of endoscopists. It's been suggested that perhaps the pressure felt by both the mentors and students to succeed during hands-on training of endoscopic retrograde cholangiopancreatography (ERCP) might lead to lower success rate and higher complication rate. We compared the success rate and complications between patients for hands-on training courses and matched control patients. Patients and Methods: From January 2002 to December 2006, all patients who underwent ERCP during hands-on training courses at gastrointestinal endoscopy conferences in China were included. Clinical and endoscopic characteristics including age, gender, indication, therapeutic intervention, success rate, and complication were collected. Conference, patient and endoscopist-related variables were analyzed for potential risk factors associated with post-ERCP complications. Differences in ERCP outcomes between domestic and foreign mentors were also compared. Results: Nine conferences with hands-on ERCP training including 124 patients were held in seven endoscopy centers. There were no significant differences in gender ratio, age, indication, and therapeutic interventions between patients for hands-on training (n = 124) and controls (n = 124). The success rates and overall complication rates were similar between the two groups (91.9% vs. 92.7%, p = 0.811; 12.9% vs. 9.7%, p = 0.422, respectively). Domestic mentors encountered more post-ERCP complications than foreign mentors (18.0% vs. 0%, p = 0.001). Univariate analyses showed that large-scale conference (p = 0.004), first-time mentorship (p = 0.015), small case volume in the past for the mentor (p = 0.015) were significantly associated with post-ERCP complications. Conclusions: The success rate and overall complication rate in patients for hands-on training were similar to those of routine ERCP procedures. Large-scale conference, first time mentorship and small case volume in the past for the mentor may be associated with post-ERCP complications.