INDIANAPOLIS -- Patients who seek treatment from physicians who more frequently perform a high-risk endoscopic procedure are less likely to be admitted to the hospital or require a repeat procedure. Unfortunately, 90 percent of physicians performing these procedures do very few of them.
This is the principal finding of an Indiana University School of Medicine and Regenstrief Institute study published Nov. 18, 2013, in the journal Medical Care reporting the results of 16,968 endoscopic retrograde cholangiopancreatography, or ERCP, procedures performed by 130 Indiana Network for Patient Care physicians from 2001 to 2011.
ERCP is the most complex endoscopic procedure performed by gastroenterologists, with about 500,000 performed in the United States each year.
According to the article "Lower Provider Volume Is Associated with Higher Failure Rates for Endoscopic Retrograde Cholangiopancreatography," physicians who performed fewer than 117 ERCPs each year were grouped as low providers, and those who performed more were classified as high providers, based on the authors' analysis. Nearly 90 percent of ERCP providers perform fewer than two ERCPs each week.
ERCP is performed to diagnose and treat conditions of the bile duct and pancreatic duct. Conditions that could necessitate the use of ERCP include gallstones, acute and chronic pancreatitis with a blockage, or an obstruction from a malignant tumor such as pancreatic cancer. The procedure is usually performed under general anesthesia.
Failure rates following the procedure were defined as patients who required a second ERCP or a related procedure, including surgery, within seven days of the first procedure. Other than failure or a complication from the first ERCP, it is exceedingly unlikely that a patient should require a second procedure in such a short time frame.
"Risks of the procedure are essentially doubled with a second ERCP," said Gregory A. Co
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