UK ERCP sedation practices, patient comfort and endoscopist characteristics: National Endoscopy Database (NED) analysis on behalf of the JAG and BSG

Correspondence to Dr David Beaton, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, TS19 8PE, UK; [email protected]

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Endoscopic retrograde cholangiopancreatography (ERCP) is a frequently performed gastrointestinal endoscopy procedure, but it is associated with a significant risk of complications.

• The absence of national-level data on ERCPs undermines quality improvement efforts.

WHAT THIS STUDY ADDS

• The National Endoscopy Database now enables monitoring of ERCP activity at both local and national levels in the UK, facilitating workforce planning and efforts to enhance the quality of care.

• While conscious sedation remains a generally safe option for most patients and prescribing has improved since the last large audit of UK practice, certain groups, such as young females, continue to experience high levels of discomfort even with high doses of conscious sedation.

• The majority of ERCP endoscopists were male gastroenterologists, and many did not meet recommended annual procedure volumes.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• The availability of performing ERCPs under deep sedation or general anaesthesia should aid quality improvement efforts and alleviate discomfort rates, particularly for patients who experience poor tolerance of ERCP under conscious sedation.

• Additional research is necessary to investigate the reasons behind ERCP endoscopists with low annual procedure numbers and to assess the impact on procedural quality.

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is a common gastrointestinal endoscopic procedure used to address pancreatico-biliary conditions. Despite its widespread use, ERCP carries a high risk of complications, with a procedure-related mortality rate of 0.3%.¹ To guarantee optimal patient care, it is essential to regularly evaluate ERCP practices. A previous large-scale audit of ERCP in the UK raised concerns, such as inadequate sedation practices and a high proportion of low-volume facilities and practitioners.²

To enhance the quality and provision of ERCP services in the UK, the British Society of Gastroenterology (BSG) released the document ‘ERCP—the way forward—a standards framework’ in 2014.³ However, the extent of its implementation remains uncertain due to the absence of national ERCP data, hindering efforts to improve service delivery.

The National Endoscopy Database (NED) offers a solution to this challenge by providing data directly from electronic endoscopy reports—through automatic data upload—without adding to the workload of endoscopists.⁴ With over 95% of UK...