How to measure quality in endoscopic retrograde cholangiopancreatography (ERCP)

The Saudi Gastroenterology Association guidelines for quality indicators in gastrointestinal endoscopic procedures

The quality and safety of gastrointestinal endoscopy varies considerably across regions and facilities worldwide. In this field, quality management has traditionally focused on individual performance of endoscopists, with most indicators addressing process measures and limited evidence of improvement in health outcomes. Indicators of quality can be classified according to their nature and sequence. The various professional societies and organizations have proposed many systems of indicators, but a universal system is necessary so that healthcare professionals are not overburdened and confused with a variety of quality improvement approaches. In this paper, we propose guidelines by the Saudi Gastroenterology Association pertaining to quality in endoscopic procedures aiming to improve the awareness of endoscopy unit staff toward important quality indications to enhance and standardize quality of care provided to our patients.

Diagnosis, treatment, and prevention of iatrogenic injury at the biliary-pancreatic-enteric junction

The biliary-pancreatic-enteric junction is prone to a variety of diseases, including calculi, inflammatory thickening, and tumors, which are easy to cause stenosis or obstruction and need timely treatment. Due to the complex anatomy and unique pathophysiological characteristics of the site, iatrogenic injuries are easy to occur during various examinations or treatment operations, and the injuries are often hidden and not easy to find intraoperatively. If not treated early, the injuries often cause serious consequences with a high mortality. Therefore, it is of great significance to study the causes, diagnosis, treatment, and prevention of iatrogenic injury at the biliopancreatic junction. This article will discuss the prevention, diagnosis, and treatment of iatrogenic injury at the biliary-pancreatic-enteric junction and summarize our diagnosis and treatment experience.

Development and validation of a risk prediction model and scoring system for post-endoscopic retrograde cholangiopancreatography pancreatitis

Background

A few models have been proposed for the prediction of the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP), but many include factors that are not assessed routinely. Herein, we intend to develop and validate a predictive model for the occurrence of PEP.

Methods

Data of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) from January 01, 2016 to May 16, 2019 (training set and internal test set) and from May 17, 2019 to December 25, 2019 (external test set) were retrospectively collected. The performance of the model was validated in the two validation cohorts.

Results

A total of 342 patients were included for the external test set, and 47 (13.7%) developed PEP. The variables included in the scoring system were gastrectomy history, high direct bilirubin (DBIL), high albumin (ALB), villous type of papillary orifice, nodular type of papillary orifice, pancreatic guidewire passages, precut sphincterotomy, and high operator experience. A total score >5 indicated high risk. In the external test set, the area under the curve (AUC) was 0.718, the sensitivity was 0.723, and the specificity was 0.676. In the external test set, the probability of PEP was 6.1%, 17.0%, and 37.5% in patients with low (<0), moderate (0-5), and high (>5) risk scores, respectively.

Conclusions

This study established a scoring system for predicting the risk of PEP using routinely measured clinical variables. Its application in routine work warrants further investigation.