The impact of center and endoscopist ERCP volume on ERCP outcomes: a systematic review and meta-analysis

Background and aims: Endoscopist experience and center volume might be associated with endoscopic retrograde cholangiopancreatography (ERCP) outcomes, as in other fields of endoscopy and in surgery. An effort to assess this relationship is important to improve practice. This systematic review and meta-analysis aimed to evaluate these comparative data and assess the impact of endoscopist and center volume on ERCP procedure outcomes. Methods: We performed a literature search in PubMed, Web of Science and Scopus through March 2022. Volume classification included high- and low-volume (HV and LV) endoscopists and centers. The primary outcome was the impact of endoscopist and center volume on ERCP success. Secondary outcomes included the overall AEs rate, and the specific AEs rate. The quality of the studies was assessed using the Newcastle-Ottawa scale. Data synthesis was obtained by direct meta-analyses using a random-effects model; the results were presented as odds ratios (OR) with 95% confidence intervals (CI). Results: Of 6833 relevant publications, 31 studies met the inclusion criteria. Procedure success was higher among HV endoscopists ([OR=1.81(95%CI,1.59-2.06),I2=57%] and in HV centers [OR=1.77(95%CI,1.22-2.57),I2=67%]. The overall AEs rate was lower for procedures performed by HV endoscopists [OR=0.71(95%CI,0.61-0.82),I2=38%] and in HV centers [OR=0.70(95%CI,0.51-0.97),I2=92%]. Bleeding was less frequent in procedures performed by HV endoscopists [OR=0.67(95%CI,0.48-0.95),I2=37%], but did not differ based on center volume [OR=0.68(95% CI,0.24-1.90),I2=89%]. No statistical differences were detected concerning pancreatitis, cholangitis, and perforation rates. Conclusion: High-volume endoscopists and centers provide higher ERCP success rates with fewer overall adverse events, especially bleeding, compared to the respective low-volume comparators.