Risk factors influencing cannulation success rate of hands-on training of endoscopic retrograde cholangiopancreatography

Objective To investigate risk factors decreasing cannulation success rate of trainees receiving hands-on ERCP training and to improve the level of ERCP training. Methods Clinical data of 1 193 ERCP cases involved in training in Xijing Hospital of Digestive Disease from December 2012 to December 2014 were retrospectively analyzed. Multivariate logistic regression analysis was performed to investigate the risk factors influencing cannulation success rate of trainees. Results There were 1 165 and 28 patients undergoing common biliary duct (CBD)cannulation and pancreatic duct(PD)cannulation respectively. The success rate of CBD cannulation by trainees was 58.5%(681/1 165)and the overall success rate was 97.9%(1 140/1 165). PD cannulation success rate by trainees was 39.3%(11/28)and the overall success rate was 89.3%(25/28). The overall complication incidence was 8.0%(96/1 193)and the incidence of post-ERCP pancreatitis was 4.4%(53/1 193). Multivariate logistic regression analysis showed that the selective cannulation by trainees was more likely to fail in patients with malignant biliary stricture(OR=0.44, 95%CI: 0.28-0.67, P<0.01), benign or undetermined biliary stricture(OR=0.32, 95%CI: 0.17-0.60, P<0.01), suspected sphincter of Oddi dysfunction(SOD)(OR=0.28, 95%CI: 0.16-0.47, P<0.01), coexisting hypertension(OR=0.65, 95%CI: 0.44-0.96, P<0.05), RDW≥48 fL(OR=0.69, 95%CI: 0.51-0.92, P<0.05), PLT<100×109/L(OR=1.68, 95%CI: 1.05-2.71, P<0.05). Conclusion Biliary stricture, suspected sphincter of Oddi dysfunction, coexisting hypertension, abnormal RDW and PLT were independent risk factors influencing cannulation success rate by trainees during hands-on ERCP training. Key words: Cholangiopancreatography, endoscopic retrograde; Selective cannulation; Training