Success Rates for Procedures (Select all procedures attempted)

ERCP Quality Network
1. Date MM/DD/YYYY

13. Main Papilla Foundο Successο Failure

2. Patient ID #/Sequence # _____

14. Deep Biliary Cannulation
Precut needed for Biliary Access?

ο Successο Yesο Failureο No

15. Pancreatic Cannulation

ο Successο Failure

16. Biliary Sphincterotomy

ο Successο Failure

17. Biliary Stone (<10mm)

ο Success ο Partial ο Failure

18. Biliary Stone (>10mm)

ο Success ο Partial ο Failure

19. Low Biliary Stent Insertionο Success20. Hilar Stent Insertionο Success ο Partial ο Failure

21. Biliary Brushingο Success22. Stricture Balloon Dilation

ο Success ο Partial ο Failure

3. Difficulty Grade123
4. Main Indication/Context
o Obstructive Jaundice (malignant or ?M)o Abn. Liver testso Stone, known or probableo Pancreatitis, acute, activeo Pancreatitis, idiopathic, recurrent
o Pancreatits, chronico Pancreatic pseudocyst/leako Pain-chronic, ? causeo Pain-intermittent, e.g. post-chole (includes ?SOD)o Biliary post-surgical problem (leak, stricture)o Stent service- biliary (ie change or remove)o Stent service-pancreatic (ie change or remove)o Clarify biliary image findingso Clarify pancreatic image findingso Tumor ablationo Other context
5. ASA Grade12345

6. Sedation Levelo Moderate/conscious
o Generalo Propofol/MAC
7. Trainee Hands-On (%)
o 0%
o 1-25%o 26-50%o 51-75%
o 76-99%
o 100%

23. Main Pancreatic Sphincterotomy ο Successο Failureο Failureο Failure

24. Pancreatic Stone Extraction

ο Success ο Partial ο Failure

25. Pancreatic Stent for therapyο Successο Failure

26. Pancreatic Stent for Prophylaxis ο Successο Failure

27. Minor Papilla Cannulation

ο Successο Failure

28. Minor Papilla Sphincterotomy

ο Successο Failure

29. Minor Papilla Stent

ο Successο Failure

30. Biliary Manometry

ο Successο Failure

31. Pancreatic Manometry

ο Successο Failure

32. Ampullectomy

ο Successο Failure

33. Pseudocyst Drainage

ο Successο Failure

34. Other therapyο Successο Failure

8. Total Scope Time _____ min (<180)
9. Total Fluoroscopy Time _____ min (<60)
10. Admission Statuso Not admitted overnighto Admitted overnight-Plannedo Admitted overnight-Unplannedo Inpatiento Day-case transfer
11. Procedure failed/incomplete before?
o Yes
o No
12. Prior Endoscopic Intervention?
o Noneo Biliary Sphincterotomy
o Pancreatic Sphincterotomy
o Minor papilla Sphincterotomy
o Biliary stent in placeo Pancreatic stent in place

Complications
Complete this section one week post procedure.
Date of onset
35. Pancreatitis
ο Mild ο Moderate ο Severe ο Fatal MM/DD/YYο None36. Bleedingο Mild ο Moderate ο Severe ο Fatal MM/DD/YY

37. Infection

ο Mild ο Moderate ο Severe ο Fatal MM/DD/YYο Noneο None38. Perforation at
ο Mild ο Moderate ο Severe ο Fatal MM/DD/YYο NoneSphincterotomy
39. Perforation, Luminal ο Mild ο Moderate ο Severe ο Fatal MM/DD/YYο None40. Cardiopulmonaryο Mild ο Moderate ο Severe ο Fatal MM/DD/YYο None41. Other complication ο Mild ο Moderate ο Severe ο Fatal MM/DD/YYο NoneOther complication description _________________________________

Definitions
Difficulty Grade in ERCP (modified from Schutz)
Diagnostic

Grade 1 Standard

Selective deep cannulation
Biopsy and cytology

Grade 2 Advanced

Billroth II diagnostics
Minor papilla cannulation

Grade 3 Tertiary

Sphincter manometry
Whipple/Roux-en-Y
Intraductalendoscopy

Therapeutic
Biliary sphincterotomy
Stones <10mm
Stents for biliary leaks
Stents for low tumors
Prophylactic small pancreatic stentStones >10mm
Hilar tumor stent placement
Benign biliary strictures
Billroth II therapeutics
Intrahepatic stones
Pancreatic therapies
Ampullectomy
Pseudocyst drainage

ASA GradeASA Grade12345Definition
Normal healthy individual
Mild systemic disease that does not limit activitySever systemic disease that limits activity but is not incapacitating
Incapacitating systemic disease which is constantly life threatening
Moribund, not expected to 24 hours with or without surgery

Source: www.surgical-tutor.org.uk/defaulthome.htm?core/preop/fitness.htm~right

ERCP Complications, Definitions and Documentation
The consensus conference (Cotton et al, GI Endo, 1991, 37, 383-393) defined a complication as:• An adverse, unplanned event,• Attributable to the procedure (including prep),• Of a severity requiring hospital admission, or prolongation of planned/actual admission.
Thus, bleeding visible at the time of sphincterotomy or polypectomy is not counted as a complication statistic unless there is evidence of
bleeding after the procedure.
Definitions and grading system for the major complications of ERCP and therapy
Bleeding

Perforation

Mild
Clinical (i.e. not just endoscopic) bleeding
Haemoglobin drop <3g, and no need fortransfusion
Possible, or only very slight leak of fluid orcontrast, treatable by fluids and suction for 3 daysor less

Moderate

SevereTransfusion (4 units or less), no
angiographic intervention or surgery

Transfusion (5 units or more), orintervention (angiographic or surgicalAny definite perforation treated
medically for 4-10 days

Medical treatment for more than 10days, or intervention (percutaneousdrainage or surgical)
Hospitalization for more than 10 daysor haemorrhagic pancreatitis,
phlegmon, or pseudocyst, orintervention (percutaneous drainage
or surgical)

Clinical pancreatitis, amylase at least 3 times
normal at more than 24 h after the procedure,
requiring admission or prolongation of planned
admission to 2-3 days

Pancreatitis requiring hospitalizationof 4-10 days

Infection(cholangitis)>38C for 24-48hFebrile or septic illness requiring
more than 3 days of hospitaltreatment or endoscopic or
percutaneous intervention)

Septic shock or surgery

Basketimpaction

Basket released spontaneously or by repeat
endoscopy

Percutaneous intervention

Surgery

Pancreatitis*Severity of other events is determined by the length of the needed hospitalization. Less than 3 days = “Mild”: 4-9 days = “Moderate”: 10+days and/or any event requiring ICU admission or unplanned surgery is deemed “Severe”.
Timing and attribution: Adverse events can occur days, weeks and even months after the event (e.g. infection transmission, sphincterotomystenosis). These direct events should be counted whenever they occur. The use of the word “attributable” in the definition clearly introduces apotential for biased reporting, especially for delayed indirect events such as pulmonary or cardiac events. We have suggested an arbitrary cutoffof 3 days for attribution for these indirect events.