2005 SAGES Abstracts

ABSTRACTS Friday, April 15, 2005
to be a routine part of imaging.
S090
TRAINING SURGEONS IN ERCP, Gary C Vitale MD, Carlos M
Zavaleta MD,John C Binford,Gerald M Larson,David S Vitale,
Department of Surgery and Center for Advanced Surgical
Technologies, University of Louisville, Louisville, Kentucky
40292, USA
Upper GI endoscopy is commonly performed by surgeons outside
major medical centers. Endoscopic training and experience
with manipulation of the distal common bile duct are
mandated by the American Board of Surgery. This report
focuses on post-residency training in ERCP.
Thirteen fellows have been trained since 1992 for periods of 6
to 14 months. Fellows were involved in 2008 cases of the 3641
ERCPs done in the intervals. Nine fellows had some previous
endoscopy experience but none had ERCP training. Nine fellows
had one-year training, two had 6 months, and one each
had 8 and 14 months. As a mark of cannulation success, a
benchmark of 85% was considered excellent. Fellows? training
was evaluated in 3-month intervals. All fellows reached an
85% success rate in at least one interval and some in more
than one. The ability to achieve an 85% cannulation rate
required, on average, 7.1 months and 102 procedures. Four of
13 fellows (31%) reached the 85% mark in the first 3-month
period, 2 of 13 (15%) in the second period, 5 of 11 (45%) in the
third period, 7 of 10 (70%) in the fourth period, and 1 of 1
(100%) in the fifth period of training. In the first period, attendings
had a stronger hands-on introductory/assistant role with
the fellows, which may explain the higher initial success. Prefellowship
training in upper GI endoscopy facilitated earlier
success with ERCP. The morbidity and mortality rates were 2.4
and 0.006% respectively and did not differ between fellows
and attendings. Twelve of 13 fellows entered practice (3 in academics).
Ten have continued to perform ERCPs.
ERCP training is possible within a surgical department that has
a dedicated faculty with experience in the procedure. An
added benefit was increased operative experience in pancreatic
disease for general surgery trainees. The learning curve is
steep enough that meaningful training would require at least 6
months of dedicated effort.
S091
NATIONAL ANALYSIS OF IN-HOSPITAL CHOLEDOCHOLITHIA-
SIS MANAGEMENT RESOURCE UTILIZATION USING PROPEN-
SITY SCORES, B K Poulose MD, P G Arbogast PhD,M D
Holzman MD, Vanderbilt Univ. School of Med.
BACKGROUND: Two treatment options exist for choledocholithiasis
(CDL): endoscopic retrograde cholangiopancreatography
(ERCP) and common bile duct exploration (CBDE).
Resource utilization measured by total in-hospital charges
(THC) and length of stay (LOS) was compared using the
propensity score (PS). In this study, PS was the probability that
a patient received CBDE based on comorbidities, hospital
traits, and demographics. The power of this method lies in balancing
groups on variables by PS, resulting in 90% bias reduction
and improved inferential validity compared to traditional
analytic techniques.
METHODS: Laparoscopic cholecystectomy (LC) patients with
CDL who had ERCP or CBDE were identified in the 2002 U.S.
Nationwide Inpatient Sample. Patients were ordered into 5 PSbased
strata. Mean THC and LOS were compared. A linear
regression model was used to estimate the contribution that
LOS had on THC.
RESULTS: 46,684 LC patients had CDL. Mean age was 52.6±0.2
years (mean±SEM) with 70% women. ERCP was performed in
44,053 (94%) and CBDE in 2,631 (6%). Mean THC was less for
CBDE ($25,641±1,966) compared to ERCP ($31,158±871;
p