ThP3.15 - Trends in ERCP in a new city teaching hospital; is there a learning curve for a unit?

Abstract

Abstract Aims Describe trends in volume, demographics, and complications over time for endoscopic retrograde cholangiopancreatography (ERCP) in a new endoscopy unit. Methods Prospective recording of all ERCPs in a new city teaching hospital commenced when the unit opened in 2015. This registry recorded patient demographics, indications, procedural data and complications. We analysed annual trends over time using linear regression. Results 4504 ERCPs were performed during the study period (1/6/15-31/5/23), with a female predominance of 58%. Median age (70 years, interquartile range 59-80) was unchanged over the study period, however the proportion under 30 years had decreased over time (4%-1%, slope -0.93, p=0.042). Total number of procedures per year has decreased over time (peak 628 in 2016, falling to 438 in 2022). The proportion performed for stone disease has fallen over the study period (80%-71%, slope -0.07, p=<0.001). Though not a statistically significant difference, the rate of ERCP pancreatitis has had a clinically significant decrease over time (5.4%-3.9%, slope -0.033, p=0.32). Conclusion A number of changes in practice have occurred since three units were merged into one unit. We routinely give diclofenac and IV fluids post-procedure. We now preferentially treat younger stone patients with laparoscopic cholecystectomy and common bile duct exploration. This results in an evolving use of contemporary ERCP with an older patient cohort with an increased indication of cancer and other reasons and fewer total numbers. These factors will contribute to a lower incidence of pancreatitis post-procedure but cannot discount a learning curve effect for a new unit.