GI Unit Leadership: Optimizing Endoscopy Operations through Leadership (Virtual) | February 2025-ASGE interventions to improve ERCP EUS performance

ASGE interventions to improve ERCP EUS performance

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The document from the American Society for Gastrointestinal Endoscopy (ASGE) focuses on enhancing the quality indicators of Endoscopic Retrograde Cholangiopancreatography (ERCP) and Endoscopic Ultrasound (EUS). Authored by the ASGE Quality Assurance in Endoscopy Committee, it reviews interventions to augment the performance of these complex procedures, crucial for the management and palliation of pancreaticobiliary diseases.<br /><br />ERCP and EUS have become widespread since their inception, but data on improving their quality when deficiencies occur is limited. The document revisits the quality indicators outlined in 2015, systematically evaluates existing literature, and proposes interventions to better these indicators via a structured methodology using Population, Intervention, Comparison, and Outcome (PICO) questions.<br /><br />For ERCP, significant recommendations include the use of prone patient positions, sphincterotomes rather than cannulas, and advanced cannulation techniques to improve cannulation rates. Wire-guided cannulation is suggested over traditional techniques to reduce post-procedural pancreatitis. The use of NSAIDs, pancreatic stents, and aggressive hydration with lactated Ringer’s solution is advised to mitigate post-ERCP pancreatitis risks. For stone extraction, balloons are preferable over baskets, and the incorporation of cholangioscopy may verify complete ductal clearance.<br /><br />In EUS, implementing consistent use of the American Joint Committee on Cancer (AJCC) staging system is encouraged. Diagnostic rates of pancreatic masses can potentially be improved with fanning techniques, deep sedation, or core biopsy needles when rapid on-site cytology evaluation is unavailable. Given the lack of robust evidence guiding the enhancement of these indicators, the document underscores a need for further research focused on refining quality in clinical practice.<br /><br />Conclusively, while outlining current practices and suggesting recommendations, the document highlights the necessity for ongoing investigation to identify further effective interventions. These efforts aim to elevate the consistency and reliability of ERCP and EUS, ultimately enhancing patient outcomes.

Keywords

ASGE

ERCP

EUS

quality indicators

pancreaticobiliary diseases

PICO methodology

cannulation techniques

post-ERCP pancreatitis

cholangioscopy

AJCC staging system