Sa1401 How Well Are WE Doing? Results of a Nationwide ERCP Quality Registry

Sa1401 How Well Are WE Doing? Results of a Nationwide ERCP Quality Registry Vivian E. Ekkelenkamp*, Robert A. De Man, Frank Ter Borg, Pieter Ter Borg, Marco J. Bruno, Marcel Groenen, Bettina E. Hansen, Antonie J. P. Van Tilburg, Erik Rauws, Arjun D. Koch Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands; Gastroenterology and Hepatology, Deventer Hospital, Deventer, Netherlands; Gastroenterology and Hepatology, Ikazia Hospital, Rotterdam, Netherlands; Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, Netherlands; Gastroenterology and Hepatology, Sint Franciscus Gasthuis, Rotterdam, Netherlands; Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure with high risk of complications. Despite significant interest by health authorities, patient organizations and insurance companies, data on procedural outcome and quality of ERCP in general and academic practice are sparse. The aim of this study was to assess procedural outcome of ERCP within a large prospective registry in the Netherlands and to evaluate associations between endoscopist-related factors and procedural outcome. Methods: All endoscopists performing ERCP in the Netherlands were invited to register their ERCPs over a one-year period using the Rotterdam Assessment Form for ERCP (RAF-E). Primary outcome measure was procedural success. A priori difficulty level of the procedure was classified according to Schutz. Baseline characteristics of the endoscopist, e.g. previous experience, were recorded at study entry. Regression analysis was performed to identify predictors of procedural outcome. Results: A total of 8575 ERCPs was registered by 171 endoscopists from 61 centers. This entails about 50% of all ERCPs performed in that period nationwide. Overall procedural success was 85.8%. An intact papillary anatomy was present in 5106 patients (59.5%): procedural success in this subset of patients was 83.4% versus 89.4% after sphincterotomy (p!0.001). Multivariable logistic regression identified “degree of difficulty”, “intact papillary anatomy”, and “previous ERCP failure” to be independently associated with procedural failure. “Yearly volume of ERCPs” was independently associated with success. This becomes even more apparent when stratified for procedural difficulty (Figure 1). Conclusions: Our nationwide prospective RAF-E registry proved to be a valuable tool to gain insight in procedural outcome of ERCPs. The overall procedural success rate for ERCP was 85.8%. Factors predictive of outcome include Schutz classification (degree of difficulty), papillary anatomy, previous ERCP failure and ERCP volume. We advocate an ongoing quality registry in order to monitor and improve ERCP quality.