Glomsaker Tom, Søreide Kjetil, Aabakken Lars, Søreide Jon Arne
Department of Surgery, Stavanger University Hospital, Stavanger, Norway.
Scand J Gastroenterol. 2011 Jan;46(1):116-21. doi: 10.3109/00365521.2010.513063. Epub 2010 Aug 24.
The introduction of non-invasive imaging for biliary-pancreatic diseases has changed the indications and volumes of endoscopic retrograde cholangiopancreatography (ERCP) over time. This study aimed to provide national figures on ERCP in Norway over the last decade.
Data from four national surveys on ERCP activity collected from 1998 to 2009 at the surgical and medical departments of all Norwegian hospitals were analyzed for variations in volumes among centers, regions, and specialties over time.
A total of 42,260 procedures were reported (average 3842 procedures per year, range 3492-4632). The number of hospitals with ERCP decreased from 41 to 35 and the annual number of procedures decreased by 13% (from 4632 to 4036), but the number of ERCP endoscopists remained stable at ~100. The proportion of procedures performed by surgeons decreased from 40% to 32% (p < 0.001) during the first half of the study period; the number of gastrointestinal surgeons performing ERCP remained stable in the latter half (46% and 48% for 2004 and 2008, respectively). In 2004, 15 endoscopists signed up for a formal ERCP training program, including 8 (53%) surgeons. This number increased to 21 (48%) in 2008. A non-significant decrease in referrals (49% in 2002 vs. 35% in 2005) between various ERCP centers was reported. Regional variation in ERCP volumes leveled off during the study period.
Though the number of both procedures and hospitals performing ERCP in Norway decreased, the proportion of low-volume and high-volume centers remained steady. The proportion of procedures by gastroenterological surgeons decreased significantly, yet roughly half of the endoscopists in ERCP training programs are surgeons. Regional variation in the ERCP numbers appears to have diminished.
随着时间的推移，胆道胰腺疾病无创成像技术的引入改变了内镜逆行胰胆管造影术（ERCP）的适应证和使用量。本研究旨在提供挪威过去十年中ERCP的全国数据。
分析了1998年至2009年期间在挪威所有医院的外科和内科收集的四项关于ERCP活动的全国性调查数据，以了解不同时间中心、地区和专业之间使用量的变化情况。
共报告了42260例手术（平均每年3842例，范围为3492 - 4632例）。开展ERCP的医院数量从41家减少到35家，年手术例数减少了13%（从4632例降至4036例），但ERCP内镜医师数量保持稳定，约为100人。在研究期的前半段，外科医生实施的手术比例从40%降至32%（p < 0.001）；在后半段，实施ERCP的胃肠外科医生数量保持稳定（2004年和2008年分别为46%和48%）。2004年，15名内镜医师报名参加正式的ERCP培训项目，其中包括8名（53%）外科医生。2008年这一数字增至21名（48%）。据报告，不同ERCP中心之间的转诊率有不显著下降（2002年为49%，2005年为35%）。研究期间，ERCP使用量的地区差异趋于平稳。
尽管挪威开展ERCP的手术例数和医院数量均有所减少，但低手术量和高手术量中心的比例保持稳定。胃肠外科医生实施的手术比例显著下降，但在ERCP培训项目中约一半的内镜医师是外科医生。ERCP数量的地区差异似乎已经缩小。
