The First Clinical Medical School of Lanzhou University; Lanzhou, China.
Division of Gastroenterology, UC Davis Medical Center and Sacramento VA Medical Center, Sacramento, CA, USA.
Turk J Gastroenterol. 2021 Jan;32(1):1-10. doi: 10.5152/tjg.2020.19562.
Endoscopic retrograde cholangiopancreatography (ERCP) is technically demanding and carries significant risks. It is performed by gastrointestinal and surgical endoscopists. There is no consensus on the minimum number of ERCPs required during training. This study was conducted to analyze the minimum number of clinical ERCPs that a trainee needs to perform to achieve competency. PubMed, Ovid-Embase, and the Cochrane library were searched systematically for prospective and retrospective studies reporting on trainees' ERCP performance. Mete-analysis was conducted to analyze the success rate of cannulation, other basic techniques, and adverse event rate, using the random-effect model with Review Manager 5.3. Thirteen studies met the inclusion criteria, with 149 trainees performing a total of 18 794 ERCP procedures. The pooled cannulation success rate was 85.7% (95% CI: 78.1%-91.0%) at completion of training. The cannulation success rate was 76.5% (95% CI: 69.2%-82.5%) when the trainees had completed 180 ERCPs, which increased to 81.8% (95% CI: 69.8%-90.6%) after 200 ERCP procedures. Adverse events and post-ERCP pancreatitis rates were 4.7% (95% CI: 2.9%-9.1%) and 2.0% (0.9%-3.9%), respectively. Achieving a cannulation success rate of >90% was considered a quality indicator for ERCP training by most societal guidelines. However, our retrospective analysis indicated that trainees only attained a pooled cannulation success rate of only 81.8% after 200 procedures. Therefore, the minimum number of ERCPs required to achieve competency during training may need to be redefined to meet the basic requirement.
内镜逆行胰胆管造影术（ERCP）技术要求高，风险大。它由胃肠和外科内镜医生进行。对于培训期间需要进行的最低 ERCP 数量，尚无共识。本研究旨在分析受训者完成 ERCP 所需的最低数量，以达到胜任力。通过系统检索 PubMed、Ovid-Embase 和 Cochrane 图书馆，对报告受训者 ERCP 表现的前瞻性和回顾性研究进行了荟萃分析。使用 Review Manager 5.3 进行随机效应模型荟萃分析，分析了插管成功率、其他基本技术和不良事件发生率。13 项研究符合纳入标准，共有 149 名受训者共进行了 18794 次 ERCP 操作。培训结束时，插管成功率为 85.7%（95%CI：78.1%-91.0%）。当受训者完成 180 次 ERCP 时，插管成功率为 76.5%（95%CI：69.2%-82.5%），完成 200 次 ERCP 后增加至 81.8%（95%CI：69.8%-90.6%）。不良事件和 ERCP 后胰腺炎的发生率分别为 4.7%（95%CI：2.9%-9.1%）和 2.0%（0.9%-3.9%）。大多数学会指南认为，>90%的插管成功率被认为是 ERCP 培训的质量指标。然而，我们的回顾性分析表明，受训者在 200 次操作后仅达到 81.8%的 pooled 插管成功率。因此，培训期间达到胜任力所需的最低 ERCP 数量可能需要重新定义，以满足基本要求。
