A Clinical Audit of Endoscopic Retrograde Cholangiopancreaticogram of Patients performed in a Secondary Care Hospital
Introduction: Recent advances in ERCP techniques are developed to improve its efficacy and safety but there are limited data regarding the efficacy and safety of ERCP carried out in secondary care hospital setting using modern techniques.
Objective: To perform a clinical audit of ERCP of patients performed in secondary care hospital.
Materials and Methods: Cross-sectional study conducted at the Department of Gastroenterology hospital, Lahore from Jan 2018 - Dec 2018. After approval from the ethical committee and informed consent from subjects, detailed demographic information was collected and entered into a structured questionnaire. A total of 66 ERCP were included in the study by non-probability consecutive sampling. Data was analyzed in SPSS ver: 21.0. Frequency and percentages were calculated for qualitative variables like gender and diagnosis and complications.
Results: A total of 66 ERCP were performed. The mean age of patients was 57.35 + 12.30. 36.4% were male and 63.6% were female in our study. 53.0% had malignant ERCP findings and 47.0% had benign pathology. Among malignant conditions were proximal CBD malignant strictures (25.8%), distal CBD stricture with ampullary growth (9.0%), distal malignant CBD stricture (6.0%), long distal malignant CBD stricture (9.0%), and complete malignant obstruction mid CBD (3.1%).
Conclusion: The ERCP services provided at secondary care hospital are standardized with a desirable outcome. The rate of its technical success is comparable to tertiary care setting and complication rates are low alone with mortality related to the procedure.
2. Freeman ML, Nelson DB, Sherman S. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335:909–18.
3. Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc 2002;56:S273–82.
4. Christensen M, Matzen P, Schulze S. Complications of ERCP: a prospective study. Gastrointest Endosc 2004;60:721–31.
5. Masci E, Toti G, Mariani A. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001;96:417–23.
6. American Society for Gastrointestinal Endoscopy (ASGE). Principle of training in gastrointestinal endoscopy. Gastrointestinal Endoscopy 1999;49:845–53.
7. Joint Advisory Group on Gastrointestinal Endoscopy. Guidelines on the training, appraisal and assessment of trainees in GI endoscopy, London; JAG, 2004. http://www.thejag.org.uk/JAG_2004.pdf
8. Williams EJ, Taylor S, Fairclough P. Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice. Gut 2007;56:821–9.
9. Cotton PB. Income and outcome metrics for the objective evaluation of ERCP and alternative methods. Gastrointest Endosc 2002;56:S283–90.
10. Kiraz N, Et L, Akgun Y. Rapid detection of Mycobacterium tuberculosis from sputum specimens using the FASTPlaqueTB test. Int J Tuberc Lung Dis 2007;11:904–8.
11. Freeman ML, DiSario JA, Nelson DB. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001;54:425–34.
12. Vandervoort J, Soetikno RM, Tham TC. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002;56:652–6.
13. Nylander D, Mitchison HC, Bell GD. A one year audit of day case ERCP. GUT 2001;48:A96.
14. Freeman ML, Nelson DB, Sherman S. Same day discharge after endoscopic biliary sphincterotomy. Gastrointest Endosc 1999;49:580–15.Mehta SN, Pavone E, Barkun AN. Outpatient therapeutic ERCP: a series of 262 consecutive cases. Gastrointest Endosc 1996;44:443–9.
15. JRB Green and The UK ERCP Stakeholders Working Party – The future of training and ERCP service in UK – A strategy. BSG August 2007.
16. Vikramjit Mitra, Harriet Mitchison, David Nylander. Endoscopic retrograde cholangio-pancreatography services can be accessible and of a high standard in a district general hospital. BMJ 2011; 3 93): http://dx.doi.org/10.1136/flgastro-2011-100084.
17. Nalankilli K, Kannuthurai S, Moss A. A modern approach to ERCP: maintaining efficacy while optimising safety. Dig Endosc. 2016 Apr;28 Suppl 1:70-6. DOI: 10.1111/den.12592.
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