Date of Award

2012

Document Type

Thesis

Degree Name

Master of Science (MS)

Department

Gastroenterology and Hepatology

College

College of Graduate Studies

First Advisor

Thomas C. Hulsey

Second Advisor

Joseph Romagnuolo

Third Advisor

Paul J. Nietert

Fourth Advisor

Daniel T. Lackland

Abstract

Background and Objective: Success in achieving deep biliary cannulation success in native papillae is an accepted measure of competence in ERCP training and practice. This study aimed to determine the factors associated with native papilla deep biliary cannulation success, with and without precut sphincterotomy. Methods: A retrospective analysis was conducted in a prospectively collected database. The main outcome was deep biliary cannulation success, with and without precut facilitating access, in non-operated papillae. Multilevel random fixed effect multivariate model was used to control for doctor factor. Results: 13018 ERCPs were performed by 85 endoscopists between March 2007, and May 2011. Conventional (without precut) and overall (some precut assistance) cannulation rates were 89.8% and 95.6%, respectively. Precut was performed in 876 (6.7%). Conventional success was more likely in outpatients (OR 1.21), but less likely in complex contexts (OR 0.59), sicker patients (AS A grade (II, III/V: OR 0.81, 0.77)), with trainee involvement (OR 0.53), and certain indications (strictures, active pancreatitis). Overall cannulation success (some facilitated by precut) had similar associations, but was more likely with higher volume endoscopists (> 239/year: OR 2.79), endoscopists with efficient fluoroscopy practice (OR 1.72), and less likely with moderate (versus deeper) sedation (OR 0.67).Conclusion: Success in deep biliary cannulation was high in this self-selected group of endoscopists, but was influenced by both patient and practitioner factors. Patient- and case-specific factors have greater impact on conventional cannulation success, but volume influences overall (including precut-assisted) success; both can be used to select appropriate cases and may help with credentialing guidelines.

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