title: Prospective multicenter quality assessment of endotherapy of biliary stones: does center volume matter?
abstract: OBJECTIVE
  To study the effectiveness of endoscopic treatment for biliary stones in a large case list of patients treated in units with different experience and different workloads in a region of northern Italy.
  
  
  METHODS
  We prospectively studied 700 patients undergoing endoscopic retrograde cholangiopancreatography or sphincterotomy, in 14 units (> or < 200 examinations/year), for their first treatment of biliary stones. The difficulty of the examinations, the results in terms of clearance of the stones, and the late outcomes (24 months) were recorded. A questionnaire (GHAA-9modified) was administered 24 hours and 30 days after the procedure to measure patient satisfaction.
  
  
  RESULTS
  There were six units with a heavy workload and eight with a light schedule. There were 176 (25.1 %) difficult examinations (Schutz grades 3, 4, and 5). Stones were found in 580 (82.9 %) and were cleared in 504 of these patients (86.9 %). No differences were observed in the clearance of stones for the different groups of difficulty and high- and low-volume centers. Over the 24-month follow-up period, 96 patients (13.7 %) complained of recurrent symptoms and 44 (6.3 %) had proof of stones. In all, 603 questionnaires were evaluable and more than 80 % of patients expressed satisfaction.
  
  
  CONCLUSIONS
  Our findings confirm the effectiveness of endoscopic treatment of biliary stones. However, the number of patients with symptoms (13.7) after 24 months, with or without persistence of stones, was not insignificant. It is feasible to record patient satisfaction, and in this series patients stated they were satisfied. Criticism mostly concerned pain control and explanations provided before the examination.
authors: Gastroenterology and Endoscopic Unit, S. Raffaele Hospital, Milan, Italy. masci.enzo@hsr.it
authors: E
authors: E
authors: Masci
authors: G
authors: G
authors: Minoli
authors: M
authors: M
authors: Rossi
authors: V
authors: V
authors: Terruzzi
authors: U
authors: U
authors: Comin
authors: P
authors: P
authors: Ravelli
authors: F
authors: F
authors: Buffoli
authors: A
authors: A
authors: Lomazzi
authors: M
authors: M
authors: Dinelli
authors: A
authors: A
authors: Prada
authors: A
authors: A
authors: Zambelli
authors: E
authors: E
authors: Fesce
authors: F
authors: F
authors: Lella
authors: R
authors: R
authors: Fasoli
authors: E M
authors: EM
authors: Perego
authors: E
authors: E
authors: Colombo
authors: G
authors: G
authors: Bianchi
authors: P A
authors: PA
authors: Testoni
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011336:Probability; D011446:Prospective Studies; D011787:Quality of Health Care; D018570:Risk Assessment; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic / Q000379:methods; D011795:Surveys and Questionnaires; D016896:Treatment Outcome