Patients‐related factors associated with successful cannulation of trainees during hands‐on ERCP training

Abstract

Background and aims

Hands‐on endoscopic retrograde cholangiopancreatography (ERCP) training is an essential step for trainees to grasp the technique. Cannulation success rate (CSR) is considered one of main indicators of competency of trainees. This study aimed to investigate whether patient‐related factors had an impact on the CSR of trainees.

Methods

A post‐hoc analysis of data from two multicenter studies (NCT02002650 and NCT03057769) were conducted. Patients aged 18‐90 with native papilla undergoing ERCP were eligible for this study. Only procedures involved by trainees in centers strictly following "10min criteria" for initial cannulation were enrolled. The primary outcome was the CSR by trainees.

Results

From Dec 2013 to Oct 2017, 20 trainees in 4 centers were involved in initial cannulation in 1044 patients with native papilla. The primary CSR by trainees was 61.1% (436/715), 31.5% (70/222) and 44.9% (48/107) in patients with common bile duct stone (CBDS), biliary stricture (BS) and other indications respectively (P<0.001). In multivariate analysis, indication of BS (OR, 0.31; 95%CI, 0.22‐0.44; P<0.001) and presence of type A diverticulum (OR, 1.69; 95%CI, 1.23‐2.33; P=0.001) were both independently associated with cannulation success of trainees. Biliary infection was significantly higher in BS than CBDS group (3.6% vs.0.7%, P=0.004). While other post‐ERCP complications were comparable between the two groups.

Conclusions

The indication of BS and the presence of type A diverticulum were independently associated with the success of cannulation of trainees. These findings indicated more efforts were needed for trainees to improve the ability of cannulation in the situation of BS.

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