The aim of this study is to investigate the impact of the ESGE quality improvement initiative with respect to the performance in ERCP in multicenter setting. We strived to evaluate whether there have been any changes in clinical outcomes, particularly in the incidence of post-ERCP pancreatitis, since the guideline was introduced in 2017. 

A total of six hospitals are included in this multicenter study: three academic teaching (Warendorf, Ibbenbueren, Trier) and three university hospitals (Muenster, Kiel, Oldenburg). The study examined how the introduction of the ESGE guideline affected defined quality indicators. 

Three groups were formed:

- Group I: Examinations prior to implementation of the guideline (retrospective, until 2017)

- Group II: Studies after implementation of the guideline (retrospective, 2018–2023)

- Group III: Studies after implementation of the guideline (prospective, from 2024)

The primary endpoint was the occurrence of post-ERCP pancreatitis (PEP). Secondary endpoints were the bile duct cannulation rate, stent placement in cases of biliary obstruction, and the success rate of stone extraction. 

In addition, a subgroup analysis was performed to assess the relationship between the number of examiners and the frequency of PEP.

The study is approved by the local Ethics Committee of University in Muenster and registered at ClinicalTrials.gov (NCT06727851). 

Data from over 1,200 ERCPs from four clinics are currently available. The incidence of post-ERCP pancreatitis was significantly reduced in the prospective cohort to <5%, thereby achieving the primary endpoint of the study.

The bile duct cannulation rates in all clinics met the threshold value of over 90% required by the ESGE. The further secondary endpoints, stone extraction and stent placement, were also close to the required target values, but still showed some potential for optimization. 

The subgroup analysis revealed that a higher number of examiners and thereby a lower number of investigations per person was associated with a slightly increased incidence of PEP. 

The introduction of the ESGE guideline with defined key performance measures led to an improvement in quality parameters and a reduction in post-ERCP pancreatitis in the four clinics studied. 

By adhering to key performance measurements, we were able to demonstrate that complications were avoided, hospital stays were shorter, and there were fewer repeat examinations.

The observation that a higher number of examiners is associated with a slightly increased incidence of PEP underscores the importance of examiner experience and indicates that the level of training and the supervision structure in endoscopy continue to be of central importance. Further studies should specifically address the question of what level of experience and training characteristics are necessary to ensure consistently high quality and patient safety in ERCP.