Improving Quality and Safety in the Endoscopy Unit (Virtual) | October 2024-ASGE Interventions to Improve ERCP EUS Performance

ASGE Interventions to Improve ERCP EUS Performance

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The American Society for Gastrointestinal Endoscopy (ASGE) aims to improve the quality of Endoscopic Retrograde Cholangiopancreatography (ERCP) and Endoscopic Ultrasound (EUS) procedures, crucial for managing pancreaticobiliary diseases. The evolving practice of these procedures necessitates an evaluation of quality metrics and interventions. This document presents a systematic review of interventions that can enhance the quality of these procedures, focusing on pre- and post-procedural indicators.<br /><br />For ERCP, the interventions aim to increase the frequency of appropriate procedure indications, improve duct cannulation and stone extraction success rates, enhance stent placement, and reduce post-ERCP pancreatitis (PEP) rates. Key interventions include using prone positioning, deep sedation, sphincterotomes for cannulation, and aggressive hydration with lactated Ringer's solution to prevent PEP. High-level studies show rectal nonsteroidal anti-inflammatory drugs significantly reduce PEP among high-risk patients.<br /><br />For EUS procedures, emphasis is laid on ensuring accurate cancer staging and enhancing diagnostic sensitivity for pancreatic masses. The use of core biopsy needles over aspiration needles, deep sedation, and techniques such as the fanning method can improve diagnostic accuracy. Prophylactic antibiotics are not generally needed except in specific cases like mediastinal cyst sampling, considering the generally low complication rates associated with EUS-guided fine-needle aspiration (FNA).<br /><br />Overall, the report stresses identifying and implementing evidence-based interventions for practitioners with lower performance levels in these procedures. The lack of robust data on improving endoscopist skills highlights the need for further research in quality improvement strategies for ERCP and EUS. Future efforts should focus on standardizing performance metrics and developing clear guidelines to coach underperforming practitioners in advanced endoscopy.

Keywords

ASGE

ERCP

EUS

pancreaticobiliary diseases

quality metrics

cannulation

post-ERCP pancreatitis

diagnostic sensitivity

endoscopic procedures

quality improvement