Strategies for ERCP complications: A new performer’sexperience and strategies for beginners to avoid complications

Aim: This study aims to share our experience of our first field experience after endoscopic retrograde cholangiopancreatography(ERCP) training and share our “The starting strategy for new ERCP performer” protocol which we created to prevent severecomplications in our first year on field experienceMaterials and Methods: 190 ERCP cases performed at Health Sciences University - Kartal Dr. Lütfi Kirdar Research and EducationHospital ERCP unit between June 2018 to November 2019 are documented retrospectively. All the cases were taken to procedure through our protocol rules. The protocol is described fully with details in the text.Results: A total of 190 (89 female-101 male) patients had undergone ERCP, of which 39 were diagnostic, 151 was therapeutic. 16 (8.4%) cases were aborted during the protocol described points during the ERCP procedure to avoid complications. Five of these cases were referred to another hospital, 7 cases were performed in another session, and 3 cases underwent surgery without performing another session of ERCP due to a given diagnosis of malignancy during ERCP. All other cases are performed regularly with a cannulation success rate of 88%. Complications occurred in 7 (3.6%) cases; 2 cholangitis due to persisting bile stone, 4 pancreatitis (highest hospitalization for 4 days), and one hemorrhage. No surgery needed complications or mortality has been reported.Conclusion: We believe a new performer can reduce the rate and risk of complications for the first year of his/her to high volume andexperienced centers’ rate by using a predefined protocol.

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1. Blumgart LH, Cotton PB, Burwood R, et al. Endoscopy and retrograde choledochopancreatography in the
diagnosis of the jaundiced patient. The Lancet 1972;
300:1269-73.
2. Dickinson PB, Belsito AA, and Cramer GG. Diagnostic
value of endoscopic cholangiopancreatography.
JAMA 1973;225:944-8.
3. Anderson MA, Fisher L, Jain R, et al. Complications of
ERCP. Gastrointest Endosc 2012;75:467-73.
4. Vandervoort J, Soetikno RM, Tham TCK, et al. Risk
factors for complications after performance of ERCP.
Gastrointest Endosc 2002; 56:652-6.
5. Salminen P, Laine S, and Gullichsen R. Severe and fatal
complications after ERCP: Analysis of 2555 procedures
in a single experienced center. Surg Endosc 2008;
22:1965-70.
6. Freeman ML. Understanding risk factors and
avoiding complications with endoscopic retrograde
cholangiopancreatography. Curr Gastroenterol Rep
2003;5:145-53.
7. Masci E, Mariani A, Curioni S, et al. Risk Factors for Pancreatitis Following Endoscopic Retrograde
Cholangiopancreatography: A Meta-Analysis.
Endoscopy 2003; 35:830-4.
8. Doppl WE, Weber HP, Temme H, et al. Evaluation of
ERCP- and endoscopic sphincterotomy-induced
pancreatic damage: a prospective study on the
time course and the significance of serum levels of
pancreatic secretory enzymes. Eur J Med Res 1996;
1:303-11.
9. Rabenstein T and Hahn EG. Post-ERCP pancreatitis:
is the endoscopist’s experience the major risk factor.
JoP 2002;3:177-87.
10. Murray WR. Reducing the Incidence and Severity of
Post Ercp Pancreatitis. Scand J Surg 2005;94:112-6.
11. Cotton PB, Garrow DA, Gallagher J, et al. Risk factors
for complications after ERCP: a multivariate analysis
of 11,497 procedures over 12 years. Gastrointest
Endosc 2009;70:80-8.
12. Cheng C-L, Sherman S, Watkins JL, et al. Risk Factors
for Post-ERCP Pancreatitis: A Prospective Multicenter
Study. Am J Gastroenterol 2006;101:139-47.
13. Verma D, Gostout CJ, Petersen BT, et al. Establishing a
true assessment of endoscopic competence in ERCP
during training and beyond: a single-operator learning
curve for deep biliary cannulation in patients with
native papillary anatomy. Gastrointest Endosc 2007;
65:394-400.
14. Ekkelenkamp V, Koch A, Rauws E, et al. Competence
development in ERCP: the learning curve of novice
trainees. Endoscopy 2014;46:949-55.
15. Wani S, Hall M, Wang AY, et al. Variation in learning
curves and competence for ERCP among advanced
endoscopy trainees by using cumulative sum analysis.
Gastrointest Endosc 2016;83:711-9.
16. Testoni PA, Mariani A, Giussani A, et al. Risk Factors
for Post-ERCP Pancreatitis in High- and Low-Volume
Centers and Among Expert and Non-Expert Operators:
A Prospective Multicenter Study. Am J Gastroenterol
2010;105:1753-61.
17. Loperfido S, Angelini G, Benedetti G, et al. Major early
complications from diagnostic and therapeutic ERCP:
a prospective multicenter study. Gastrointest Endosc
1998;48:1-10.
18. Varadarajulu S, Kilgore ML, Wilcox CM, et al.
Relationship among hospital ERCP volume, length of
stay, and technical outcomes. Gastrointest Endosc
2006;64:338-47.
19. Lella F, Bagnolo F, Colombo E, et al. A simple way of
avoiding post-ERCP pancreatitis. Gastrointest Endosc
2004; 59:830-4.
20. Vila JJ. Post-endoscopic retrograde
cholangiopancreatography complications: How
can they be avoided? World J Gastrointest Endosc
2012;4:241.
21. Ding X, Chen M, Huang S, et al. Nonsteroidal anti-
inflammatory drugs for prevention of post-ERCP
pancreatitis: a meta-analysis. Gastrointest Endosc
2012;76:1152-9.