title: Papillotomy Performance Scoring Scale--a pilot validation study focused on the cut axis.
abstract: BACKGROUND
  No published Papillotomy Performance Scoring Scale exists.
  
  
  OBJECTIVE
  To develop such a scale and to apply it to stratify the quality of performance of recorded papillotomies.
  
  
  METHODS
  Expert biliary endoscopists were polled regarding their opinion of a 'perfect' biliary papillotomy and experience with complications in relation to the cut axis. Based on these responses a scoring scale encompassing two components - wire alignment and cut orientation, was proposed. This scoring scale was presented to experienced and trainee endoscopists, who scored recording of five biliary papillotomies. The mean final combined score was used for stratification.
  
  
  RESULTS
  The experts' opinion of a 'perfect' biliary papillotomy is one cut along the axis of the distal bile duct and papilla. Their reported experience with complications occurring outside of the perfect axis validated their consensus. Application of the scoring scale stratified recorded papillotomies based on the mean final combined scores.
  
  
  CONCLUSIONS
  These pilot data support the hypothesis that a scoring scale focused on the cut axis can be constructed based on expert opinion, experience and consensus. The possibility of stratification of mean final combined scores that are significantly different validates application of the scoring scale for assessment of papillotomy performance.
authors.affiliation: Research and Medical Services, Sacramento Veterans Affairs Medical Center, Veterans Affairs Northern California Healthcare System, CA, USA. jwleung@ucdavis.edu
authors.forename: J W
authors.initials: JW
authors.lastname: Leung
authors.forename: F W
authors.initials: FW
authors.lastname: Leung
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D006801:Humans; D015588:Observer Variation; D010865:Pilot Projects; D012016:Reference Values; D016717:Sphincterotomy, Endoscopic / Q000592:standards*