Grading scales that accurately anticipate the complexity and risk of endoscopic retrograde cholangiopancreatography (ERCP) would be valuable for appropriate decision-making, triage, and informed consent. This study sought to retrospectively validate the previously described scale for complexity of ERCP developed by the American Society for Gastrointestinal Endoscopy (ASGE) (Gastrointest Endosc 2011;73:868-874
). Complexity grade, technical success, and complications were recorded for 1355 procedures on 934 patients over a 12-month period. Patients had a mean age of 58 years and were balanced by gender and complexity grades (Grade 1+2=29%, 3=51%, and 4=20%). 88% of Grade 4 patients had altered anatomy. Cannulation was more successful in grades 1-3 than 4 (98% vs 88%, p<0.05). Complications were similar among the groups, occurring in 10% overall, with rates for post-ERCP pancreatitis of 5.4% and bleeding of 1.5%. Perforations were more common among grade 4 cases (4 cases, 1.5%) than among grades 1-3 (3 cases, 0.3%, p=0.010).
Prospective validation and potential refinement of the intermediate grades of the ASGE criteria are the next steps. In the meantime, practitioners can readily employ the currently available scale to inform their decision-making about in whom, by whom, and when difficult procedures might best be performed.
Sahar N, La Selva D, Gluck M, et al. The ASGE grading system for ERCP can predict success and complication rates in a tertiary referral hospital. Surg Endosc 2019;33:448-453. (https://doi.org/10.1007/s00464-018-6317-7)