Individual and practice differences among physicians who perform ERCP at varying frequency: a national survey

Gastrointest Endosc. 2011 Jul;74(1):65-73.e12. doi: 10.1016/j.gie.2011.01.072. Epub 2011 Apr 14.


Background: ERCP practice patterns in the United States are largely unknown.

Objective: To characterize the ERCP practice of U.S. gastroenterologists, stratified by their annual case volume: high volume (HV, >200), moderate volume (MV, 50-200), and low volume (LV, <50).

Design: Anonymous electronic survey.

Subjects: American Society for Gastrointestinal Endoscopy members who are practicing U.S. gastroenterologists.

Results: Among all responders (N = 1006), 63% were derived from community practices. Physicians who performed ERCPs and provided data on annual volume (n = 669) were classified as LV (n = 254), MV (n = 284), and HV (n = 131). During training, 77% of LV physicians did not complete 180 ERCPs compared with 58% of MV and 34% of HV physicians (P < .0001). Only 58% of LV physicians enjoy performing ERCP compared with 88% of MV and 98% of HV physicians (P < .0001); 60% reported being "very comfortable" with ERCP compared with more than 90% of MV and HV physicians (P < .0001). LV physicians are less comfortable with pancreatic duct stenting (PDS) (57% vs 92% [MV] and 98% [HV], P ≤ .02) and using prophylactic PDS. Although HV physicians (42%) were least likely to use short-wire devices (P < .02), use of wire-guided cannulation was similar (74% LV, 72% MV, 66% HV, P = .13). Thirty-seven percent of LV physicians reported comfort with needle-knife sphincterotomy compared with 75% (MV) and 99% (HV) (P < .0001).

Limitations: Survey completion rate of 18.5%.

Conclusions: Self-reported comfort and/or enjoyment with ERCP is lower among LV physicians. Wire-guided cannulation is used by the majority of all ERCP practitioners, but prophylactic PDS is less frequently used by LV physicians. Because many LV physicians perform ERCP for higher-grade indications and use advanced techniques (eg, needle-knife sphincterotomy), further LV physician ERCP outcomes data are needed.

MeSH terms

  • Cholangiopancreatography, Endoscopic Retrograde / statistics & numerical data*
  • Cross-Sectional Studies
  • Gastroenterology / statistics & numerical data*
  • Health Care Surveys
  • Humans
  • Job Satisfaction
  • Pancreatic Ducts
  • Professional Practice / statistics & numerical data*
  • Prosthesis Implantation / statistics & numerical data
  • Stents / statistics & numerical data
  • United States