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The ASGE grading system for ERCP can predict success and complication rates in a tertiary referral hospital

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Abstract

Background

The utility of the American Society for Gastrointestinal Endoscopy (ASGE) grading scale assessing complexity of endoscopic retrograde cholangiopancreatography (ERCP) has not been evaluated in clinical practice.

Methods

Patients that underwent ERCP between January 2015 and December 2015 were included. Procedural difficulty was graded according to the grading system proposed by the ASGE workshop. Technical success rates and complications were recorded.

Results

A total of 1355 ERCPs were performed on 934 patients. Patients were equally divided with respect to gender and had a mean age of 58 years (range 29–86). 391 cases were grade 1, 2 (29%), 695 were grade 3 (51%), and 269 were grade 4 (20%). Altered anatomy was observed in 88% of grade 4 patients. Cannulation was achieved in 98% of cases graded 1–3 and in 88% of cases graded 4 (p < 0.05). Complications were recorded in 10% of all cases with post-ERCP pancreatitis (5.4%) and procedure-related bleeding (1.5%) being the more common ones. No statistically significant difference was noted between the groups with regard to complications. Three perforations were seen in grade 1–3 cases (0.3%) compared to 4 cases in grade 4 cases (1.5%), (p = 0.01).

Conclusion

The grading system proposed by the ASGE workshop can aid in predicting cannulation success and perforation rates in ERCP. Based on this retrospective study, the most complex ERCP procedures can be achieved with encouraging rates of success. There is a need to validate our study with prospective ones performed in other high-volume centers.

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References

  1. Yachimski PS, Ross A (2017) The future of endoscopic retrograde cholangiopancreatography. Gastroenterology 153:338–344

    Article  PubMed  Google Scholar 

  2. Ahmed M, Kanotra R, Savani GT, Kotadiya F, Patel N, Tareen S, Fasullo MJ, Kesavan M, Kahn A, Nalluri N, Khan HM, Pau D, Abergel J, Deeb L, Andrawes S, Das A (2017) Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): a cross-sectional US experience. Endosc Int Open 5::E261–E271

    Article  Google Scholar 

  3. Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, Eloubeidi MA, Fanelli RD, Faulx AL, Gurudu SR, Kothari S, Lightdale JR, Qumseya BJ, Shaukat A, Wang A, Wani SB, Yang J, DeWitt JM (2017) Adverse events associated with ERCP. Gastrointest Endosc 85:32–47

    Article  PubMed  Google Scholar 

  4. Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-Menachem T, Cash BD, Decker GA, Early DS, Fanelli RD, Fisher DA, Fukami N, Hwang JH, Ikenberry SO, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Shergill AK, Dominitz JA (2012) Complications of ERCP. Gastrointest Endosc 75:467–473

    Article  PubMed  Google Scholar 

  5. Schutz SM, Abbott RM (2000) Grading ERCPs by degree of difficulty: a new concept to produce more meaningful outcome data. Gastrointest Endosc 51:535–539

    Article  CAS  PubMed  Google Scholar 

  6. Ragunath K, Thomas LA, Cheung WY, Duane PD, Richards DG (2003) Objective evaluation of ERCP procedures: a simple grading scale for evaluating technical difficulty. Postgrad Med J 79:467–470

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Cotton PB, Eisen G, Romagnuolo J, Vargo J, Baron T, Tarnasky P, Schutz S, Jacobson B, Bott C, Petersen B (2011) Grading the complexity of endoscopic procedures: results of an ASGE working party. Gastrointest Endosc 73:868–874

    Article  PubMed  Google Scholar 

  8. Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A Jr, Petersen BT, Petrini JL, Pike IM, Rabeneck L, Romagnuolo J, Vargo JJ (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454

    Article  PubMed  Google Scholar 

  9. Ekkelenkamp VE, de Man RA, Ter Borg F, Borg PC, Bruno MJ, Groenen MJ, Hansen BE, van Tilburg AJ, Rauws EA, Koch AD (2015) Prospective evaluation of ERCP performance: results of a nationwide quality registry. Endoscopy 47:503–507

    Article  PubMed  Google Scholar 

  10. Williams EJ, Ogollah R, Thomas P, Logan RF, Martin D, Wilkinson ML, Lombard M (2012) What predicts failed cannulation and therapy at ERCP? Results of a large-scale multicenter analysis. Endoscopy 44:674–683

    Article  CAS  PubMed  Google Scholar 

  11. Olsson G, Arnelo U, Swahn F, Tornqvist B, Lundell L, Enochsson L (2017) The H.O.U.S.E. classification: a novel endoscopic retrograde cholangiopancreatography (ERCP) complexity grading scale. BMC Gastroenterol 17:38

    Article  PubMed  PubMed Central  Google Scholar 

  12. Adler DG, Lieb JG, Cohen J, Pike IM, Park WG, Rizk MK, Sawhney MS, Scheiman JM, Shaheen NJ, Sherman S, Wani S (2015) Quality indicators for ERCP. Am J Gastroenterol 110:91–101

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Avenue, C3-GAS, Seattle, WA, 98101, USA

    Nadav Sahar, Danielle La Selva, Michael Gluck, S. Ian Gan, Shayan Irani, Michael Larsen, Andrew S. Ross & Richard A. Kozarek

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  1. Nadav Sahar
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  2. Danielle La Selva
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  3. Michael Gluck
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  4. S. Ian Gan
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  5. Shayan Irani
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  6. Michael Larsen
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  7. Andrew S. Ross
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  8. Richard A. Kozarek
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Correspondence to Nadav Sahar.

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Disclosures

Dr. Nadav Sahar, Daniella La Selva, Dr. Michael Gluck, Dr. S. Ian Gan, Dr. Shayan Irani, Dr. Michael Larsen, Dr. Andrew S. Ross, and Dr. Richard A. Kozarek have no conflicts of interest or financial ties to disclose.

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Sahar, N., La Selva, D., Gluck, M. et al. The ASGE grading system for ERCP can predict success and complication rates in a tertiary referral hospital. Surg Endosc 33, 448–453 (2019). https://doi.org/10.1007/s00464-018-6317-7

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  • DOI: https://doi.org/10.1007/s00464-018-6317-7

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