Results of endoscopic retrograde cholangiopancreatography procedures at surgical clinics: A multicenter observational study in Türkiye.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary (HPB) diseases. The need for ERCP has increased with the rising number of HPB diseases over the past decade. Thus, due to increased demand, ERCP is performed at more centers. Currently, it is performed by general surgeons, gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology (BSG).

Aim: To present the results of ERCP procedures from fourteen surgical centers in Türkiye.

Methods: Fourteen surgical centers performing ERCP were included in the present study. The age, gender, ERCP indication, success status, post-ERCP complications, ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers. The results are discussed according to the targets declared by the BSG, which are volume load per annum, proportion of successful cannulation (> 85%), bile duct clearance rate (> 75%), stenting rate for strictures (> 80%) and complications (< 6%).

Results: A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024. 29250 (43.6%) of the procedures were performed urgently, especially for suppurative cholangitis, biliary tract injuries, etc. The remaining 37743 (56.4%) cases were performed electively. 50.2% of the patients were female and 49.8% were male. The average ages were 56.5 years for women and 55.9 years for men. General anesthesia was used in 84.1% of the patients while sedation was used in 15.9%. The indications were bile duct stone (78.7%), pancreatic tumor (3.9%), papillary tumor (3.3%), cholangiocarcinoma (2.6%), Oddi sphincter dysfunction (2.4%), bile leakage after cholecystectomy (2%), bile leakage after hydatid cyst surgery (1.9%), biliary stricture (1.7%), and other diseases (3.1%). Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1% of the patients. They were usually self-limited and responded to supportive measures. The frequency of the other complications was also consistent with the literature.

Conclusion: There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries. As patients requiring ERCP usually present to surgical practitioners, the incorporation of surgeons into this training program is an effective and reliable solution. The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists. This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye. The results suggest that the surgical centers included were able to achieve the targets set by the BSG. This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service. There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP. Therefore, ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.