ERCP biliary stenting practice; A prospective multicenter study

Methods: Six centers offering comprehensive ERCP services used the GI-Trac database prospectively to analyze and compare endoscopy practices. There were 3 University referral centers (Medical University of SC; University of CA, Davis; McGill University, Montreal), two Veterans Affairs Hospitals (Durham NC, Portland OR) and one Air Force Hospital (San Antonio TX). Results: Among 2181 ERCPs, 306 patients received biliary stents, of which only 28 (9%) were metallic. Indications for polyethylene biliary stents were: malignancy (49%), temporary for stones (16%), biliary leaks (15%), benign biliary strictures (14%), and temporary for sphincter dysfunction (7%). Of the malignancies, 57% were pancreatic, 37% biliary, and 6% papillary. 78% of polyethylene stents were of 10 French Gauge (FG), 20% were 7 FG (mainly used for leaks and sphincter dysfunction), and 2% were 11.5 FG. Only 20% of patients receiving polyethylene stents for malignancy underwent biliary sphincterotomy, and only 3% received more than one biliary stent. Complications occurred in only 10 (3.6%) of patients receiving polyethylene stents; half of the complications were mild, and only 1 (0.3%) was fatal. Prophylactic stent exchange was planned in less than half of the patients receiving polyethylene stents for malignancy. Expandable metal stents were used only for malignancy, all with sphincterotomy, and, in 20 (71%) of 28 cases, only after failure of previous polyethylene stenting. There were no significant differences in the patterns of activity measured in the different centers. Conclusions: A shared database allows comparison of practices in different health care environments, analysis of differences, and a powerful method for clinical research and quality control.