Quality and competence in endoscopic cholangiography. Towards certainty

• Published in: Acta gastroenterologica latinoamericana Vol. 45; no. 1; pp. 37 - 45
• Main Authors: Guidi, Martín, Hwang, Hui Jer, Curvale, Cecilia, Souto, Gonzalo, De María, Julio, Ragone, Fernando, Promenzio, Esteban, Matano, Raúl
• Format: Journal Article
• Language: Spanish
• Published: Argentina 01.03.2015
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biliary Tract Diseases - surgery; Child; Child, Preschool; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholangiopancreatography, Endoscopic Retrograde - standards; Clinical Competence; Female; Humans; Male; Middle Aged; Patient Satisfaction; Quality Indicators, Health Care; Retrospective Studies; Risk Assessment; Treatment Outcome; Young Adult
• ISSN: 0300-9033

The American Society of Gastroenterology (ASGE) and the American College of Gastroenterolog (ACG) have established indicators to recognize high-quality studies in endoscopic retrograde cholagiopancreatography (ERCP). The indicators were: a) Pre-procedure: adequate indication, informed consent, assessment of the degree of difficulty of the procedure and antibiotic prophylaxis. b) Intraprocedure: cannulation, choledocholithiasis extraction and stents placement rates. c) Postprocedure: full documentation and complications rates. Between October 2010 and October 2012 we performed a retrospective, descriptive, observational and self-evaluative study to assess the compliance with ERCP quality indicators proposed by the ASGE. Preprocedural indicators were evaluated in 734 studies. Cannulation, choledocolithiasis extraction and stents placement under the hiliar bifurcation rates were 96.2%, 95.4% and 100%, respectively. The complication rate was 5.6% and the mortality was 0.27%. The severity of complications was evaluated according to the classification of Masci (30 mild, 7 moderate and 4 severe). Quality is a basic tool that allows the comparison between our actions and the indicators already predetermined as suitable. The appropriate indication is an indicator to improve. We believe that 12% of registered normal studies could be due to a difficult accessibility to magnetic resonance cholangiography in our health system. Achievement of the internationally validated indicators place us as a high-quality endoscopic cholagiography unit and as a training center with appropriate expertise.