Performance measures for ERCP and endoscopic ultrasound: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Authors: Dirk Domagk, Kofi W. Oppong, Lars Aabakken, Laszlo Czakó, Tibor Gyökeres, Gianpiero Manes, Peter Meier, Jan-Werner Poley, Thierry Ponchon, Andrea Tringali, Cristina Bellisario, Silvia Minozzi, Carlo Senore, Cathy Bennett, Michael Bretthauer, Cesare Hassan, Michal F. Kaminski, Mario Dinis-Ribeiro, Colin J. Rees, Cristiano Spada, Roland Valori, Raf Bisschops, Matthew D. Rutter

Abstract

The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). We recommend that endoscopy services across Europe adopt the following seven key and one minor performance measures for EUS and ERCP, for measurement and evaluation in daily practice at center and endoscopist level:

1. Adequate antibiotic prophylaxis before ERCP (key performance measure, at least 90%);
2. Antibiotic prophylaxis before EUS-guided puncture of cystic lesions (key performance measure, at least 95%);
3. Bile duct cannulation rate (key performance measure, at least 90 %);
4. Tissue sampling during EUS (key performance measure, at least 85%);
5. Appropriate stent placement in patients with biliary obstruction below the hilum (key performance measure, at least 95%);
6. Bile duct stone extraction (key performance measure, at least 90%);
7. Post-ERCP pancreatitis (key performance measure, less than 10 %).
8. Adequate documentation of EUS landmarks (minor performance measure, at least 90%).

This present list of quality performance measures for ERCP and EUS recommended by ESGE should not be considered to be exhaustive: it might be extended in future to address further clinical and scientific issues.

1 Rate of adequate bowel preparation (minimum standard 90 %);
2 Cecal intubation rate (minimum standard 90%);
3 Adenoma detection rate (minimum standard 25%);
4 Appropriate polypectomy technique (minimum standard 80%);
5 Complication rate (minimum standard not set);
6 Patient experience (minimum standard not set);
7 Appropriate post-polypectomy surveillance recommendations (minimum standard not set).

Other identified performance measures have been listed as less relevant based on an assessment of their importance, scientific acceptability, feasibility, usability, and comparison to competing measures.

Introduction

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have identified quality of endoscopy as a major priority. The rationale for this priority and the methodology of the quality initiative process have been described elsewhere [1]. The aim of the ESGE pancreatobiliary endoscopy working group was to identify a list of key performance measures for EUS and ERCP that would be universally applicable. As with previous ESGE performance measures [2, 3] the focus was on metrics that met the following requirements:

proven impact on clinically relevant outcomes or quality of life; well-defined, and amenable to simple and robust measurement; and applicability to all levels of endoscopy services. This paper describes the methodological process utilized [1] and reports the agreed list of key performance measures for pancreatobiliary endoscopy.