Impact of skill and experience of the endoscopist on the outcome of endoscopic sphincterotomy techniques

Background: Our aim was to assess the influence of the skill and experience of the endoscopist on the success and risk of endoscopic sphincterotomy te chniques. Methods: The outcome of all endoscopic sphincterotomies (n = 1335) carried out between 1988 and 1995 were retrospectively analyzed with respect to the endoscopist performing the procedure. Endoscopists were differentiated acc ording to whether they had previous experience with endoscopic sphincteroto my techniques (n > 100) and the frequency of endoscopic sphincterotomy duri ng the study period (> 40, 26 to 40, 10 to 25, < 10 per year). Results: Indications for endoscopic sphincterotomy techniques and technical execution had only a minor influence on the results of endoscopic sphincte rotomy and were comparable for the individual endoscopists. The overall suc cess rate of endoscopic sphincterotomy was 94.4% and did not significantly differ among the endoscopists. The overall complication rate of endoscopic sphincterotomy was 7.3%. Endoscopists learning endoscopic sphincterotomy te chniques with a case frequency of less than 10 procedures per year had a co nsistently high complication rate (10.5%). Those learning endoscopic sphinc terotomy techniques with a case frequency of more than 25 procedures per ye ar had an above-average complication rate for their first 40 endoscopic sph incterotomy procedures and a significant decrease in complication rate as t he number of procedures increased. The complication rate for experienced en doscopists was 7.7%. There were distinct and, in one case, significant diff erences in complication rates between individual endoscopists (11.5% vs. 4. 8%, p = 0.01). However, when corrected for multiple testing, there were no significant differences at the p < 0.05 level. The endoscopic sphincterotom y frequency of the endoscopist was the only significant risk factor for com plications. Endoscopists with a frequency of more than 40 procedures per ye ar had a significantly lower complication rate (5.6%) than endoscopists wit h a lower case frequency (9.3%, p < 0.05). Conclusions: A low endoscopic sphincterotomy frequency is, even for endosco pists with previous experience with the procedure, a risk factor for compli cations after endoscopic sphincterotomy. The learning of endoscopic sphinct erotomy techniques requires a minimum of 40 procedures, but also after 100 procedures a further decrease of the complication rate can be expected.