A64 PERFORMING ERCP AT A CANADIAN ACADEMIC INSTITIUATION: QUALITY PROCEDURES START WITH THE RIGHT INDICATION.
Notice bibliographique
Résumé
Endoscopic Retrograde Cholangiopancreatography (ERCP) has diagnostic as well as therapeutic potential. However, given the availability of non-invasive diagnostic modalities, such as Magnetic Resonance Cholangiopancreatography (MRCP), the indications for performing ERCP have now shifted towards therapeutic procedures. In 2015, the American Society of Gastrointestinal Endoscopy (ASGE) published quality indicator guideline in ERCP. An appropriate procedural indication was considered a priority indicator and the task force selected a performance target of > 90%. There are no recent practice audits that review the indications for ERCP in Canada. Our primary outcome is to measure how often ERCP is performed in accordance with the ASGE guidelines for procedural indication. Secondary outcome measures include the diagnostic yield and adverse event rates when an ERCP is performed outside of the ASGE guidelines for clinical indication. An observational, retrospective review of all ERCPs in the central zone of the Nova Scotia Health Authority (NSHA) over a one year period between April 2015 and March 2016 was performed. New ERCP procedures were considered for inclusion in the review. 560 patients met the inclusion criteria during this time period. We accessed the patients electronic files through the Clinical Outcomes Research Initiative (CORI) data base. Basic demographic data was extracted. The procedural indications were recorded and compared with the ASGE clinical guidelines to access our compliance. The procedures that were not consistent with guidelines were analyzed further to determine a diagnostic yield and complication rate. Of the 560 procedures, 14 (2.5%) were performed for an indication inconsistent with the ASGE clinical guidelines. 6 patients (43%) met the clinical criteria for biliary Sphincter of Oddi dysfunction type III, and 4 cases (29%) were performed for biliary pancreatitis without evidence of biliary obstruction. Among the 14 ERCP procedures, common bile duct stones/sludge were actually found and removed in 5 cases (36%). There was no procedure related complications reported, however, one patient had transient oxygen desaturation during the procedure. The procedural indication for ERCP in our institution during this quality analysis appear to be consistent with the ASGE guidelines in about 97% of procedures, which is within the performance target recommended by the ASGE quality indicator guideline. In cases when ERCP was performed outside the recommended guidelines, MRCP is a reasonable option to identify the hepatobiliary pathology prior to ERCP. Although no serious adverse events were determined in this audit, larger numbers of patients over a longer period of time would be needed to conclude this. None
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».