Sm. Schutz et Rm. Abbott, Grading ERCPs by degree of difficulty: a new concept to produce more meaningful outcome data, GASTROIN EN, 51(5), 2000, pp. 535-539
Background: Simple endoscopic retrograde cholangiopancreatography (ERCP) ou
tcome measures such as success and complication rates may not allow direct
comparisons among endoscopists or centers because procedure degree of diffi
culty can vary tremendously from case to case, We propose a new grading sca
le designed to objectively quantify ERCP degree of difficulty.
Methods: A 1 to 5 scale was devised to grade ERCPs according to their level
of technical difficulty, A retrospective pilot study was performed to asse
ss ERCP outcomes at our institution according to difficulty grade. The scal
e was then prospectively applied to all ERCPs during a 1-year period,
Results: In the pilot study, 209 of 231 (90%) ERCPs were technically succes
sful, and 8 (3%) were followed by complications. Grade 1 to 4 procedures we
re more likely to succeed (94% vs, 74%, p < 0.05) and less likely to have a
ssociated complications (2% vs. 10%, p < 0.05) than grade 5/5B ERCPs, Of 18
7 ERCPs assessed prospectively, 166 (89%) were successful and 10 (5%) were
followed by complications; 132 of 138 (96%) grade 1 to 4 procedures succeed
ed compared with 30 of 46 grade 5 to 5B ERCPs (65%, p < 0.001), but complic
ations were not significantly more frequent in grade 5 to 5B ERCPs (8.7% vs
. 4.3%, p = not significant).
Conclusions: Technical success was dependent on ERCP degree of difficulty,
but complications were not. Outcome data that incorporate degree of difficu
lty information may be more meaningful, allowing endoscopist-to-endoscopist
and center-to-center comparisons.