title: Quality evaluation through self-assessment: a novel method to gain insight into ERCP performance.
abstract: BACKGROUND
  The American Society for Gastrointestinal Endoscopy Committee on Outcomes Research has recommended monitoring nine endoscopic retrograde cholangiopancreatography (ERCP)-specific quality indicators for quality assurance in ERCP. With the development of a self-assessment tool for ERCP (Rotterdam Assessment Form for ERCP-RAF-E), key indicators can easily be assessed.
  
  
  OBJECTIVE
  The aim of this study was to test in daily practice an easy-to-use form for assessment of procedural quality in ERCP and to determine ERCP quality outcomes in a tertiary referral hospital.
  
  
  METHODS
  This was a prospective study carried out in a tertiary referral hospital. In January 2008, a quality self-assessment programme was started. Five qualified endoscopists participated in this study. All ERCPs were appraised using RAF-E. Primary parameters were common bile duct (CBD) cannulation rate and procedural success. The indication was classified and procedural difficulty was graded; success rates of therapeutic interventions were measured for all different difficulty degrees.
  
  
  RESULTS
  A total number of 1691 ERCPs were performed. 1515 (89.6%) of these were appraised using RAF-E. Median CBD cannulation success rate was 94.1%. Successful sphincterotomy was accomplished in almost all patients (median 100%; range 98.2-100%). Stent placement was successful in 97.8% and complete stone extraction, if indicated, was achieved in 86.8%.
  
  
  CONCLUSIONS
  Quality indicators for ERCP can be measured using the Rotterdam self-assessment programme for ERCP. Outcome data in ERCPs obtained with this RAF-E provide insight into the quality of individual as well as group performance and can be used to assess and set standards for quality control in ERCP.
authors.affiliation: Department of Gastroenterology and Hepatology , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands.
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Ekkelenkamp
authors.affiliation: Department of Gastroenterology and Hepatology , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands.
authors.forename: Arjun D
authors.initials: AD
authors.lastname: Koch
authors.affiliation: Department of Gastroenterology and Hepatology , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands.
authors.forename: Jelle
authors.initials: J
authors.lastname: Haringsma
authors.affiliation: Department of Gastroenterology and Hepatology , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands.
authors.forename: Jan-Werner
authors.initials: JW
authors.lastname: Poley
authors.affiliation: Department of Gastroenterology and Hepatology , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands.
authors.forename: Henk R
authors.initials: HR
authors.lastname: van Buuren
authors.affiliation: Department of Gastroenterology and Hepatology , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands.
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.affiliation: Department of Gastroenterology and Hepatology , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands.
authors.forename: Robert A
authors.initials: RA
authors.lastname: de Man
keywords: ENDOSCOPIC RETROGRADE PANCREATOGRAPHY; ENDOSCOPY; GASTROINTESINAL ENDOSCOPY