Endoscopic retrograde cholangiopancreatography in pediatric and adult populations: 17-year experience from Pakistan with trends, complications, and global comparison

Table 1 Proposed quality indicators for endoscopic retrograde cholangiopancreatography

Quality indicators	Grade of recommendation	Measure type	Performance target, %	Target achieved
Pre-procedure
Frequency with which ERCP is performed for an indication that is included in a published standard list of appropriate indications, and the indication is documented (priority indicator)	1C+	Process	> 90.0	Yes
Frequency with which informed consent is obtained, including specific discussions of risks associated with ERCP, and fully documented medical consent is obtained and fully documented	1C	Process	> 98.0	Yes
Frequency with which appropriate antibiotics for ERCP are administered for settings in which they are indicated	2B	Process	> 98.0	Yes
Frequency with which ERCP is performed by an endoscopist who is fully trained and credentialed to perform ERCP	3	Process	> 98.0	Yes
Frequency with which the volume of ERCP procedures performed per year is recorded per endoscopist	1C	Process	> 98.0	Yes
Procedure
Frequency with which deep cannulation of the ducts of interest is documented	1C	Process	> 98.0	Yes
Frequency with which deep cannulation of the ducts of interest in patients with native papillae without surgically altered anatomy is achieved and documented (priority indicator)	1C	Process	> 90.0	Yes
Frequency with which fluoroscopy time and radiation dose are measured and documented	2C	Process	> 98.0	No
Frequency with which CBD stones (1 cm) in patients with normal bile duct anatomy are extracted successfully and documented (priority indicator)	1C	Outcome	> 90.0	Yes
Frequency with which stent placement for biliary obstruction in patients with normal anatomy, whose obstruction is below the bifurcation, is successfully achieved and documented (priority indicator)	1C	Outcome	> 90.0	Yes
Post-procedure
Frequency with which a complete ERCP report that details the specific techniques performed, particular accessories used, and all intended outcomes is prepared	3	Process	> 98.0	Yes
Frequency with which acute adverse events and hospital transfers are documented	3	Process	> 98.0	Yes
Rate of post-ERCP pancreatitis (priority indicator)	1C	Outcome	N/A	Yes
Rate and type of perforation	2C	Outcome	< 0.2	Yes
Rate of clinically significant hemorrhage after sphincterotomy or sphincteroplasty in patients undergoing ERCP	1C	Outcome	< 1.0	Yes
Frequency with which patients are contacted at 14 days or greater to detect and record the occurrence of delayed adverse events after ERCP	3	Process	> 90.0	Yes

CBD: Common bile duct; ERCP: Endoscopic retrograde cholangiopancreatography; N/A: Not available.