ERCP AND SPHINCTEROTOMY IN THE CONTEXT OF LAPAROSCOPIC CHOLECYSTECTOMY - ACADEMIC AND COMMUNITY PRACTICE PATTERNS AND RESULTS

Objective: To study the effect of practice setting and practitioner ex perience on the use and results of ERCP and sphincterotomy in the cont ext of laparoscopic cholecystectomy. Methods: Data were collected on 7 80 ERCPs performed before or after laparoscopic cholecystectomy. Bilia ry endoscopists at four academic centers and 33 community-based gastro enterologists of varying experience participated. Results: Indications for perioperative ERCP were similar in academic centers and community practice, but academic experts performed a significantly higher propo rtion of postoperative procedures. Success rates were high for all par ticipants, although the least experienced group of community-based gas troenterologists had a significantly lower rate of success with sphinc terotomy. Complication rates did not vary significantly among particip ants. Conclusions: Experienced community-based gastroenterologists can perform ERCP and sphincterotomy in the context of laparoscopic cholec ystectomy with results comparable to those of academic experts. Gastro enterologists with a life-time experience of fewer than 200 ERCPs have Bower success rates for sphincterotomy than more experienced practiti oners in either practice setting. ERCP performed in community or acade mic settings can provide safe and effective management of common bile duct stones and biliary leaks or strictures that occur after laparosco pic cholecystectomy.