title: Prospective evaluation of ERCP performance: results of a nationwide quality registry.
abstract: OBJECTIVE
  Despite significant interest from health care authorities, patient organizations, and insurance companies, data on procedural outcome and quality of endoscopic retrograde cholangiopancreatography (ERCP) in general and academic practice are sparse. The aims of this study were to assess procedural outcome of ERCP within a large prospective registry in The Netherlands, and to evaluate associations between endoscopist-related factors and procedural outcome.
  
  
  METHODS
  All endoscopists performing ERCP in The Netherlands were invited to register their ERCPs over a 1-year period using the Rotterdam Assessment Form for ERCP (RAF-E). The primary outcome measure was procedural success. A priori difficulty level of the procedure was classified according to Schutz. Baseline characteristics of the endoscopist (e. g. previous experience) were recorded at study entry. Regression analysis was performed to identify predictors of procedural outcome.
  
  
  RESULTS
  A total of 8575 ERCPs were registered by 171 endoscopists from 61 centers, constituting about 50 % of all ERCPs performed nationally during the study period. Overall procedural success was 85.8 %. Intact papillary anatomy was present in 5106 patients (59.5 %): procedural success in this subgroup of patients was 83.4 % vs. 89.4 % after sphincterotomy (P < 0.001). Multivariate logistic regression identified "degree of difficulty," "intact papillary anatomy," and "previous ERCP failure" to be independently associated with procedural failure. "Yearly volume of ERCPs" and "trainee involvement" were independently associated with success.
  
  
  CONCLUSIONS
  The nationwide prospective RAF-E registry proved to be a valuable tool to gain insight into procedural outcome of ERCPs.
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: Robert A
authors.initials: RA
authors.lastname: de Man
authors.affiliation: Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Ter Borg
authors.affiliation: Department of Gastroenterology and Hepatology, Ikazia Hospital, Rotterdam, The Netherlands.
authors.forename: Pieter C J Ter
authors.initials: PC
authors.lastname: Borg
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
authors.affiliation: Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Marcel J M
authors.initials: MJ
authors.lastname: Groenen
authors.affiliation: Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Bettina E
authors.initials: BE
authors.lastname: Hansen
authors.affiliation: Department of Gastroenterology and Hepatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
authors.forename: Antonie J P
authors.initials: AJ
authors.lastname: van Tilburg
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Erik A J
authors.initials: EA
authors.lastname: Rauws
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
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012042:Registries