Determination of success of ERCP after initial failure in a community hospital setting

While success rate of second attempt ERCP has been determined to be 95% in a referral center, no information is available concerning this procedure performance in the community setting. Objective: To determine the success rate of repeated ERCP after a first failed attempt by community-based gastroenterologists at a non-tertiary institution. Material and Methods: A computerized search using DRG codes for ERCP and endoscopic sphincterotomy (ES) was used to identify patients over a 46-month period (1/1/92 - 10/31/95). The study was conducted at one large community hospital (GSRMC). Those patients undergoing at least one repeated procedure had their medical records reviewed for indications and results. Results: A total of 1115 coded procedures (735 coded as ERCP, 380 coded as ES) performed at GSRMC during the study period. Three different gastroenterology groups performed 86% of these procedures: Group A (4 MDs), were involved in 38%, Group B (3 MDs) in 34% and Group C a solo practitioner, involved in 14%, of the procedures. Group D (other MDs) were involved in the remaining 14% of procedures. A total of 43 patients (3.9% of total number of procedures) underwent more than one ERCP during the study period (mean: 2.2; range 2-6). The success rates are shown below: ERCP (n) Repeat ERCP n(%) Repeat ERCP for Failure n (%) Success Repeated ERCP n(%) Group A 427 18 (4.2%) 6 (33%) 5 (83%) Group B 381 15 (3.9%) 2 (1.3%) 2 (100%) Group C 160 6 (3.7%) 0 NA Group D 147 4 (27%) 3 (75%) 2 (66%) Total 1115 43(3.9%) 11(25.5%) 9 (82%) Conclusions: In the community setting, ERCP success rates for cannulatmg the duct of interest after an initially failed attempt, by the same group of physicians is 82% This figure compares to 95% rate achieved at a large tertiary center.