Cawich, Shamir O.; Arthurs, Milton; Plummer, Joseph M.; Mitchell, Derek I. G.; Murphy, Trevor; Williams, Eric W.; McFarlane, Michael E. C.; Newnham, Mark S.; Brown, Hilary A.; Frankson, Morton A. C.
Author Affiliation, Ana.
An Evaluation of Endoscopic Retrograde Cholangiopancreatography: The Importance of Case Volume in Improving Outcome.
The Internet Journal of Third World Medicine
Date of Publication
During the first three years after its introduction to Jamaica, ERCP was performed with high morbidity and poor therapeutic success. This study evaluates the effect of increased case volumes and accrued experience on ERCP outcomes at a tertiary level hospital in Jamaica. We compared all ERCP procedures performed by a single endoscopist over eight years. The data were divided into two groups: Group A included patients who had ERCP performed during the first four years of its use (January 1, 1999 to December 31, 2002). Group B included patients who had ERCP performed during the latter four years of its use (January 1, 2003 to December 31, 2006). Outcomes were compared using Chi square statistics and Fisher's exact tests. Significance was considered present with a two-tailed P value < 0.05 There were 315 ERCPs performed in 299 patients during the study period. 14 patients were excluded from analysis, leaving 301 procedures in 285 patients. There were 79 males and 222 females, with ages ranging from 14 to 94 years (Mean +/-SD: 47 +/-20). There has been a significant increase in case volume over the study periods (1.98 vs 4.29 cases monthly, P<0.001). There has also been a change in the case mix profile, with significantly more ERCPs being performed for therapeutic indications (30.53% vs 59.71%, P=0.04), attempted CBD stenting (4.21% vs 15.53%, P=0.005) and successful stent placement (25% vs 96.88%, P = <<0.001). Currently, ERCP is performed with acceptable morbidity (6.95%) and mortality (1.07%). Local endoscopists may have now passed the learning curve for ERCP, but they must have continued access to patient lists and equipment to maintain their competence.....