The impact of transpancreatic precut sphincterotomy on the quality of ERCP in a low-volume setting

Abstract

Background and aimsAlthough quality improvement is crucial for endoscopic retrograde cholangiopancreatography (ERCP), a low practice volume can pose challenges to achieving high-quality bile duct cannulation. Transpancreatic precut sphincterotomy (TPS) has been proven effective for advanced cannulation. However, existing data mainly come from skilled endoscopists in large medical centers. The impact of TPS on ERCP quality in a lower-volume setting deserves investigation. MethodsOur hospital performs approximately 200 ERCPs annually, with one expert performing approximately half of them and three nonexpert endoscopists sharing the remaining cases. TPS was started and became our predominant advanced cannulation technique in April 2016. We retrospectively reviewed ERCP cases three years before and after the introduction of TPS. The primary endpoints of the study were the differences in two ERCP quality indicators, the bile duct cannulation rate and the incidence of post-ERCP pancreatitis (PEP). ResultsA total of 701 ERCP cases with naïve papilla were analyzed, with 350 patients treated before the introduction of TPS and 351 patients treated afterward. The successful cannulation rate was significantly improved (before: 87.4%, after: 92.3%, P=0.032), while the incidence of PEP decreased, but not significantly (before: 4.0%, after: 2.8%, P=0.402). All endoscopists benefited from utilizing TPS, with nonexperts demonstrating a significantly higher improvement in the cannulation rate (before: 85.5%, after: 93.1%, P=0.019). ConclusionsTPS can effectively enhance the quality of ERCP irrespective of practice volume.