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## Complete Summary

#### GUIDELINE TITLE

Quality indicators for endoscopic retrograde cholangiopancreatography.

#### BIBLIOGRAPHIC SOURCE(S)

Baron TH, Petersen BT, Mergener K, Chak A, Cohen J, Deal SE, Hoffman B,
Jacobson BC, Petrini JL, Safdi MA, Faigel DO, Pike IM. Quality
indicators for endoscopic retrograde cholangiopancreatography.
Gastrointest Endosc 2006 Apr;63(4 Suppl):S29-34. \[31 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16564909)

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Pancreaticobiliary disorders, including bile duct stones and malignant
obstructive jaundice

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation\
Treatment

#### CLINICAL SPECIALTY

Gastroenterology

#### INTENDED USERS

Advanced Practice Nurses\
Nurses\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

To establish quality indicators to aid in the recognition of high
quality endoscopic retrograde cholangiopancreatography (ERCP)
examinations

#### TARGET POPULATION

Patients undergoing endoscopic retrograde cholangiopancreatography

#### INTERVENTIONS AND PRACTICES CONSIDERED

Endoscopic retrograde cholangiopancreatography

#### MAJOR OUTCOMES CONSIDERED

Safety and efficacy of procedure

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Studies were identified through a computerized search of Medline
followed by review of the bibliographies of relevant articles. When such
data were absent, indicators were chosen by expert consensus.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus (Committee)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

The American Society for Gastrointestinal Endoscopy (ASGE) and the
American College of Gastroenterology (ACG), as leaders in promoting the
highest quality patient care, formed a task force to identify end points
that could be used to document high-quality endoscopic services. In most
cases these end points will require validation before they can be
generally adopted. The task force consisted of expert endoscopists
selected by the board of directors of the ASGE and the ACG.

The task force developed quality indicators for the 4 major endoscopic
procedures: colonoscopy, esophagogastroduodenoscopy (EGD), endoscopic
retrograde cholangiopancreatography (ERCP), and endoscopic
ultrasonography (EUS). Wherever possible, these indicators were chosen
because there were published supporting data. These studies were
identified through a computerized search of Medline followed by review
of the bibliographies of relevant articles. When such data were absent,
indicators were chosen by expert consensus. The goal was to create a
comprehensive list of potential quality indicators, recognizing that
only a small subset may ultimately be implemented. The resultant quality
indicators were graded on the strength of the supporting evidence.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**Grades of Recommendation**

  -------------------------------------------------------------------------------
  **Grade of         **Clarity   **Methodologic           **Implications**
  recommendation**   of          strength/supporting      
                     benefit**   evidence**               
  ------------------ ----------- ------------------------ -----------------------
  1A                 Clear       Randomized trials        Strong recommendation;
                                 without important        can be applied to most
                                 limitations              clinical settings

  1B                 Clear       Randomized trials with   Strong recommendation;
                                 important limitations    likely to apply to most
                                 (inconsistent results,   practice settings
                                 nonfatal methodologic    
                                 flaws)                   

  1C+                Clear       Overwhelming evidence    Strong recommendation;
                                 from observational       can apply to most
                                 studies                  practice settings in
                                                          most situations

  1C                 Clear       Observational studies    Intermediate-strength
                                                          recommendation; may
                                                          change when stronger
                                                          evidence is available

  2A                 Unclear     Randomized trials        Intermediate-strength
                                 without important        recommendation; best
                                 limitations              action may differ
                                                          depending on
                                                          circumstances or
                                                          patients\' or societal
                                                          values

  2B                 Unclear     Randomized trials with   Weak recommendation;
                                 important limitations    alternative approaches
                                 (inconsistent results,   may be better under
                                 nonfatal methodologic    some circumstances
                                 flaws)                   

  2C                 Unclear     Observational studies    Very weak
                                                          recommendation;
                                                          alternative approaches
                                                          likely to be better
                                                          under some
                                                          circumstances

  3                  Unclear     Expert opinion only      Weak recommendation;
                                                          likely to change as
                                                          data become available
  -------------------------------------------------------------------------------

\*Adapted from Guyatt G, Sinclair J, Cook D, Jaeschke R, Schunemann H,
Pauker S. Moving from evidence to action: grading recommendations---a
qualitative approach. In: Guyatt G, Rennie D, eds. Users\' guides to the
medical literature. Chicago: AMA Press; 2002. p. 599-608.

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

The task force consisted of expert endoscopists selected by the board of
directors of the American Society for Gastrointestinal Endoscopy (ASGE)
and the American College of Gastroenterology (ACG). These documents were
then reviewed and approved by the governing boards.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Recommendations were graded on the strength of the supporting evidence
(Grades 1A-3). Definitions of the recommendation grades are presented at
the end of the \"Major Recommendations\" field.

**Preprocedure Quality Indicators**

The generic preprocedure quality indicators discussed in the
accompanying article also pertain to performance of endoscopic
retrograde cholangiopancreatography (ERCP). Specific preprocedure
indicators and discussion pertinent to the performance of ERCP include
the following points:

1.  Appropriate indication. ERCP should be performed for an appropriate
    indication as defined in a previously published guideline (Johanson
    et al., 2002; also see the National Guideline Clearinghouse \[NGC\]
    summary of the American Society for Gastrointestinal Endoscopy
    \[ASGE\] guideline, [The Role of ERCP in Diseases of the Biliary
    Tract and the
    Pancreas](http://www.guideline.gov/summary/summary.aspx?doc_id=9295&nbr=004966)).
    An indication should be documented for each procedure, and when it
    is a nonstandard indication it should be justified in the
    documentation. **(3)**

> *Discussion*. The indications for ERCP are covered in detail in a
> separate publication and are summarized in the Table below. Clinical
> settings in which ERCP is generally not indicated include the
> following: (1) Abdominal pain without objective evidence of
> pancreaticobiliary disease by laboratory or noninvasive imaging
> studies. In this setting the yield is very low, yet the risk of
> complications is significant. When considered in this patient group,
> ERCP should only be undertaken in a setting capable of performing
> sphincter of Oddi manometry. (2) As a routine before cholecystectomy.
> Preoperative ERCP should be reserved for patients with cholangitis or
> a significant likelihood of biliary obstruction or duct stones by
> clinical criteria or imaging studies. (3) As a routine for relief of
> biliary obstruction in patients with potentially resectable malignant
> distal bile duct obstruction. Preoperative biliary decompression has
> not been shown to improve postoperative outcomes, yet it may result in
> both preoperative and postoperative complications. Preoperative relief
> of biliary obstruction is recommended in patients with acute
> cholangitis and those with intense pruritus in whom operation may be
> delayed.

**Table: Indications for ERCP**

+-----------------------------------------------------------------------+
| A.  Jaundice thought to be the result of biliary obstruction          |
|                                                                       |
| B.  Clinical and biochemical or imaging data suggestive of pancreatic |
|     or biliary tract disease                                          |
|                                                                       |
| C.  Signs or symptoms suggesting pancreatic malignancy when direct    |
|     imaging results are equivocal or normal                           |
|                                                                       |
| D.  Pancreatitis of unknown etiology                                  |
|                                                                       |
| E.  Preoperative evaluation of chronic pancreatitis or pancreatic     |
|     pseudocyst                                                        |
|                                                                       |
| F.  Sphincter of Oddi manometry                                       |
|                                                                       |
| G.  Endoscopic sphincterotomy                                         |
|                                                                       |
|     1.  Choledocholithiasis                                           |
|                                                                       |
|     2.  Papillary stenosis or sphincter of Oddi dysfunction causing   |
|         disability                                                    |
|                                                                       |
|     3.  Facilitate biliary stent placement or balloon dilatation      |
|                                                                       |
|     4.  Sump syndrome                                                 |
|                                                                       |
|     5.  Choledochocele                                                |
|                                                                       |
|     6.  Ampullary carcinoma in poor surgical candidates               |
|                                                                       |
|     7.  Access to pancreatic duct                                     |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| H.  Stent placement across benign or malignant strictures, fistulae,  |
|     postoperative bile leak, or large common bile duct stones         |
|                                                                       |
| I.  Balloon dilatation of ductal strictures                           |
|                                                                       |
| J.  Nasobiliary drain placement                                       |
|                                                                       |
| K.  Pseudocyst drainage in appropriate cases                          |
|                                                                       |
| L.  Tissue sampling from pancreatic or bile ducts                     |
|                                                                       |
| M.  Pancreatic therapeutics                                           |
+-----------------------------------------------------------------------+

2.  Informed consent. Informed consent for ERCP should focus on 5
    possible adverse outcomes: (1) pancreatitis, (2) postsphincterotomy
    hemorrhage, (3) infectious complications, usually cholangitis but
    also cholecystitis and infection of pancreatic fluid
    collections, (4) adverse cardiopulmonary reactions, usually related
    to sedation, and (5) perforation. The patient should be informed of
    the probable need for hospitalization (if outpatient) should
    complications occur and the possible need for surgical repair if
    perforation occurs. **(3)**

> *Discussion*. Some complications of ERCP are unique from those that
> occur with standard endoscopy. A review of the complications specific
> to ERCP has been published previously. Some endoscopists include in
> the informed consent process a variety of other possible outcomes
> (e.g., possible need for emergency radiologic procedures, blood
> transfusion, etc.). Patterns of practice indicate that an informed
> consent can be obtained on the day of the procedure, even in open
> access practices. The expected rate of ERCP-induced pancreatitis is
> generally between 1% and 7%, although there are several situations in
> which this rate may be significantly higher. Numerous factors, both
> patient- and procedure-related, may influence the risk for post-ERCP
> pancreatitis and need to be taken into account when planning for the
> procedure and obtaining informed consent. Cholangitis occurs in 1% or
> less and cholecystitis complicates 0.2% to 0.5% of ERCPs.
>
> Hemorrhage is most commonly a complication of endoscopic
> sphincterotomy and has been reported to occur in 0.8% to 2% of cases.
> Perforations may be guidewire induced, sphincterotomy induced, and
> endoscope induced at a site remote from the papilla. The overall
> incidence of perforation during ERCP has been reported to be 0.3% to
> 0.6%.

3.  Assessment of procedural difficulty. Identify ERCP grade of
    difficulty preprocedurally. **(3)**

> *Discussion*. The degree of difficulty of ERCP has been suggested as a
> way of assessing outcomes on the basis of procedural difficulty (Table
> below). Although it has not been prospectively validated, there is a
> general assumption that higher degrees of difficulty are associated
> with lower success rates and higher complication rates. In general,
> for all indications, competent ERCP endoscopists should expect to
> succeed in 80% to 90% of ERCP cases with a difficulty grade of 1. It
> has also been suggested that those ERCP endoscopists with lower levels
> of expertise should not attempt ERCP cases with a difficulty grade 2
> or 3.

**Table: ERCP Degrees of Difficulty**

  -----------------------------------------------------------------------
  *Grade 1: standard*\
  \
  Diagnostic: Selective deep cannulation, diagnostic sampling\
  \
  Therapeutic: Biliary sphincterotomy, stones \<10 mm, stents for leaks
  and low tumors\
  \
  *Grade 2: advanced*\
  \
  Diagnostic: Billroth II diagnostics, minor papilla cannulation\
  \
  Therapeutic: Stones \>10 mm, hilar tumor stent placement, benign
  biliary strictures\
  \
  *Grade 3: tertiary*\
  \
  Diagnostic: Manometry, Whipple, Roux-en-Y, intraductal endoscopy\
  \
  Therapeutic: Billroth II therapeutics, intrahepatic stones, pancreatic
  therapies

  -----------------------------------------------------------------------

4.  Prophylactic antibiotics. Preprocedure antibiotics should be
    administered according to published guidelines. (see the NGC summary
    of the ASGE guideline, [Guidelines for Antibiotic Prophylaxis for
    Gastrointestinal (GI)
    Endoscopy](http://www.guideline.gov/summary/summary.aspx?doc_id=4143&nbr=003179)).
    **(2B)**

> *Discussion*. Detailed guidelines for the administration of
> antibiotics before ERCP have been previously published. In brief,
> patients with known or suspected biliary obstruction, including
> primary sclerosing cholangitis, biliary or pancreatic leaks, and
> pancreatic pseudocysts or pancreatic necrosis, are at increased risk
> for procedure-related infections and should receive antibiotic
> prophylaxis.

**Intraprocedure Quality Indicators**

The intraprocedure interval begins with the administration of sedation
and ends with removal of the endoscope. Minimum performance elements
that are generic to all sedated gastrointestinal procedures include
attention to patient monitoring, medication administration, reversal or
resuscitative efforts, and photo documentation of pertinent landmarks or
pathologic conditions. Both procedure-specific and disease-specific
quality indicators can be proposed for ERCP practice, as follows.

5.  Cannulation rates. Cannulation of the duct of interest with a high
    success rate and with an associated low complication rate is
    achieved by experts in ERCP and requires adequate training and
    continued experience in ERCP. (Desired duct, **1C**; Use of precut,
    **2C)**

> *Discussion*. Cannulation of the desired duct of interest is the
> foundation for successful diagnostic and therapeutic ERCP. Deep
> cannulation is achieved when the tip of the catheter is passed beyond
> the papilla into the desired duct. This allows effective installation
> of contrast to visualize the entire ductal system of interest and the
> introduction of instruments to perform therapeutic maneuvers.
> Successful cannulation may avoid the need for a second ERCP or
> percutaneous transhepatic cholangiography (PTC) to complete the study.
> Reports from the 1990s indicate that successful cannulation rates at
> or above 95% are consistently achieved by experienced endoscopists and
> rates at or above 80% are a goal of training programs in ERCP. Thus,
> although [\>]{.underline} 90% is an overall appropriate target for
> successful cannulation, rates of [\>]{.underline} 85% should be
> achievable for most endoscopists performing ERCP. When cannulation
> rates are calculated, failed examinations because of inadequate
> sedation or prior abdominal surgery such as pancreaticoduodenectomy
> (Whipple operation), Billroth II anatomy, prior gastrojejunostomy and
> hepaticojejunostomy, and obstruction to the duodenum should be
> excluded. Additionally, procedures that are aborted because of a high
> volume of retained gastric contents or inability to achieve adequate
> sedation should be excluded.
>
> The procedure report should document whether deep cannulation was
> achieved and should in all cases specify the types of accessories used
> to achieve cannulation. One or more fluoroscopic images should be
> included. Photo documentation of endoscopically identified
> abnormalities is considered advisable by the task force.
>
> Successful cannulation of the desired duct may be achieved by precut
> sphincterotomy when standard techniques fail. Precut sphincterotomy
> has an associated learning curve and may increase the risk of
> post-ERCP procedural complications. Most experienced endoscopists do
> not rely on precut methods in more than 10% to 15% of cases and they
> should not be used as an alternative to proper cannulation techniques.
>
> Technical success of ERCP is not only dependent on successful
> cannulation. Once cannulation is achieved, other maneuvers are
> required to achieve complete technical success, including traversing
> of a stricture, extraction of stones, and successful stent placement,
> to name a few. Technical success for the most commonly performed
> procedures (stone extraction, relief of biliary obstruction, stent
> placement for bile leaks) should be achievable in [\>]{.underline}85%
> of cases. Technically failed ERCP may result in complications
> (cholangitis, pancreatitis), need for additional procedures (PTC,
> surgery, additional ERCP), and their associated costs. Although little
> is known about the technical failures of ERCP and their impact on
> cost, preliminary studies have suggested that the cost of failed ERCP
> is substantial.

6.  Extraction of common bile duct stones. Choledocholithiasis is one of
    the most common indications for ERCP. Acute cholangitis and severe
    acute gallstone pancreatitis require rapid and effective relief of
    biliary obstruction and duct clearance. **(1C)**

> *Discussion*. Some expert endoscopy centers can achieve a greater than
> 99% bile duct clearance rate for all bile duct stones. However, it
> should now be expected that competent ERCP endoscopists can clear the
> duct of common bile duct stones in \>85% of cases by use of
> sphincterotomy and balloon or basket stone extraction. When standard
> techniques fail, mechanical lithotripsy will increase the success rate
> to more than 90%, leaving a small number of patients requiring more
> advanced procedures such as electrohydraulic, laser, or extracorporeal
> shockwave lithotripsy, which will increase the success rate further to
> almost 100%.

7.  Stent placement for biliary obstruction below the bifurcation.
    Indications for placement of a biliary stent to treat an obstruction
    below the bifurcation include pancreatic cancer, nonextractable or
    large common bile duct stones, and benign strictures (chronic
    pancreatitis, postbiliary surgery). **(1C)**

> *Discussion*. Relief of obstructive jaundice from pancreatic cancer is
> a common indication for ERCP. Relief of biliary obstruction is
> mandatory in those with cholangitis and in any patient with clinical
> jaundice whose biliary tree has been instrumented and contrast
> introduced. Obstructive processes below the bifurcation are
> technically easier to achieve than hilar obstruction. Competent ERCP
> endoscopists should be able to place a biliary stent for relief of
> nonhilar biliary obstruction in\>80% to 90% of patients.

**Postprocedure Quality Indicators**

The postprocedure interval extends from withdrawal of the endoscope to
patient dismissal and, for certain elements, beyond this until
appropriate communication is completed. Minimum performance elements
common to all procedures include attention to procedure report, patient
instructions, pathology follow-up, determination of patient
satisfaction, and communication to other care providers, among others.
Postprocedure quality indicators specific to performance of ERCP include
the following:

8.  Completeness of documentation. Endoscopic reports should document
    successful cannulation, correlative fluoroscopic images, and
    endoscopic photo documentation should be obtained, when appropriate.
    **(3)**

> *Discussion*. Documentation of ERCP with representative radiographic
> images and endoscopic photos is the only way to provide evidence of
> what was performed during the procedure. Proper documentation has
> medicolegal ramifications. Additionally, documentation of these
> findings allows clinicians that are directly involved with the
> patients\' medical care to make appropriate decisions on patient
> management.

9.  Complication rates. The rates of ERCP-associated pancreatitis,
    bleeding, perforation, and cholangitis should be measured. **(1C)**

**[Definitions]{.underline}**:

**Grades of Recommendation**

  -------------------------------------------------------------------------------
  **Grade of         **Clarity   **Methodologic           **Implications**
  recommendation**   of          strength/supporting      
                     benefit**   evidence**               
  ------------------ ----------- ------------------------ -----------------------
  1A                 Clear       Randomized trials        Strong recommendation;
                                 without important        can be applied to most
                                 limitations              clinical settings

  1B                 Clear       Randomized trials with   Strong recommendation;
                                 important limitations    likely to apply to most
                                 (inconsistent results,   practice settings
                                 nonfatal methodologic    
                                 flaws)                   

  1C+                Clear       Overwhelming evidence    Strong recommendation;
                                 from observational       can apply to most
                                 studies                  practice settings in
                                                          most situations

  1C                 Clear       Observational studies    Intermediate-strength
                                                          recommendation; may
                                                          change when stronger
                                                          evidence is available

  2A                 Unclear     Randomized trials        Intermediate-strength
                                 without important        recommendation; best
                                 limitations              action may differ
                                                          depending on
                                                          circumstances or
                                                          patients\' or societal
                                                          values

  2B                 Unclear     Randomized trials with   Weak recommendation;
                                 important limitations    alternative approaches
                                 (inconsistent results,   may be better under
                                 nonfatal methodologic    some circumstances
                                 flaws)                   

  2C                 Unclear     Observational studies    Very weak
                                                          recommendation;
                                                          alternative approaches
                                                          likely to be better
                                                          under some
                                                          circumstances

  3                  Unclear     Expert opinion only      Weak recommendation;
                                                          likely to change as
                                                          data become available
  -------------------------------------------------------------------------------

\*Adapted from Guyatt G, Sinclair J, Cook D, Jaeschke R, Schunemann H,
Pauker S. Moving from evidence to action: grading recommendations---a
qualitative approach. In: Guyatt G, Rennie D, eds. Users\' guides to the
medical literature. Chicago: AMA Press; 2002. p. 599-608.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### REFERENCES SUPPORTING THE RECOMMENDATIONS

[References open in a new
window](http://www.guideline.gov/summary/select_ref.aspx?doc_id=9297)

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is identified for each recommendation.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

A high quality endoscopy ensures that the patient receives an indicated
procedure, that correct and clinically relevant diagnoses are made (or
excluded), that therapy is properly performed, and that all these are
accomplished with minimal risk.

#### POTENTIAL HARMS

Adverse events related to cholangiopancreatography include pancreatitis;
postsphincterotomy hemorrhage; infectious complications, usually
cholangitis but also cholecystitis and infection of pancreatic fluid
collections; adverse cardiopulmonary reactions, usually related to
sedation, and perforation.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   Underlying this discussion of quality indicators is the assumption
    that adequate training and credentialing has taken place before a
    practitioner begins the practice of endoscopy. The American Society
    for Gastrointestinal Endoscopy (ASGE) has guidelines specifically
    addressing standards for training, assessing competence, and
    granting privileges to perform endoscopy. It is the task force\'s
    recommendation that these guidelines be adopted by facilities where
    endoscopic procedures are performed.

-   The list of potential quality indicators was meant to be a
    comprehensive listing of measurable endpoints. It is not the
    intention of the task force that all end points be measured in every
    practice setting. In most cases, validation may be required before a
    given end point may be universally adopted.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness\
Patient-centeredness\
Safety

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Baron TH, Petersen BT, Mergener K, Chak A, Cohen J, Deal SE, Hoffman B,
Jacobson BC, Petrini JL, Safdi MA, Faigel DO, Pike IM. Quality
indicators for endoscopic retrograde cholangiopancreatography.
Gastrointest Endosc 2006 Apr;63(4 Suppl):S29-34. \[31 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16564909)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2006 Apr

#### GUIDELINE DEVELOPER(S)

American College of Gastroenterology - Medical Specialty Society\
American Society for Gastrointestinal Endoscopy - Medical Specialty
Society

#### SOURCE(S) OF FUNDING

American Society for Gastrointestinal Endoscopy

#### GUIDELINE COMMITTEE

ASGE/ACG Taskforce on Quality in Endoscopy

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Taskforce Members*: Todd H. Baron, MD; Bret T. Petersen, MD; Klaus
Mergener, MD, PhD; Amitabh Chak, MD; Jonathan Cohen, MD; Stephen E.
Deal, MD; Brenda Hoffman, MD; Brian C. Jacobson, MD, MPH; John L.
Petrini, MD; Michael A. Safdi, MD; Douglas O. Faigel, MD (*ASGE
Co-Chair*); Irving M. Pike, MD (*ACG Co-Chair*)

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[American Society for Gastrointestinal Endoscopy Web
site](http://www.asge.org/uploadedFiles/Publications_and_Products/Practice_Guidelines/2006_quality.pdf).

Print copies: Available from the American Society for Gastrointestinal
Endoscopy, 1520 Kensington Road, Suite 202, Oak Brook, IL 60523

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Bjorkman, DJ, Popp, JW. Measuring the quality of endoscopy.
    Gastrointest Endosc 2006 Apr;63(4 Suppl):S1-2. Available in Portable
    Document Format (PDF) from the [American Society for
    Gastrointestinal Endoscopy Web
    site](http://www.asge.org/nspages/practice/patientcare/sop/index.cfm).

-   Faigel, DO, Pike, IM, Baron, TH, Chak, A, Cohen, J, Deal, SE,
    Hoffman, B, Jacobson, BC, Mergener, K, Petersen, BT, Petrini, JL,
    Rex, DK, Safdi, MA. Quality indicators for gastrointestinal
    endoscopic procedures: an introduction. Gastrointest Endosc 2006
    Apr;63(4 Suppl):S3-9. Available from the [American Society for
    Gastrointestinal Endoscopy Web
    site](http://www.asge.org/PublicationsProductsIndex.aspx?id=352).

Print copies: Available from the American Society for Gastrointestinal
Endoscopy, 1520 Kensington Road, Suite 202, Oak Brook, IL 60523

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on September 14, 2006.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions.

### DISCLAIMER

#### NGC DISCLAIMER

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<http://www.guideline.gov/about/inclusion.aspx> .

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Date Modified: 11/3/2008