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Endoscopy. 2018 Nov;50(11):1116-1127. doi: 10.1055/a-0749-8767. Epub 2018 Oct 19.

Performance measures for ERCP and endoscopic ultrasound: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative.

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Department of Medicine I, Josephs Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany.
HPB Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Institute of Cellular Medicine, Newcastle University, Newcastle, United Kingdom.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Transplantation Medicine, Oslo University Hospital, Oslo Norway.
First Department of Medicine, University of Szeged, Szeged, Hungary.
Department of Gastroenterology, Medical Center Hungarian Defence Forces, Budapest, Hungary.
Department of Gastroenterology, ASST Rhodense, Rho, and Garbagnate Milanese Hospitals, Milan, Italy.
Med. Klinik II, DIAKOVERE Henriettenstift, Klinik für Enterologie, Hannover, Germany.
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Lyon, France.
Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy.
CERTT, Center for Endoscopic Research, Therapeutics and Training - Catholic University, Rome, Italy.
CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy.
Office of Research and Innovation, Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn, Dublin, Ireland.
Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway.
Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland.
Department of Gastroenterological Oncology and Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
Department of Health Management and Health Economics, University of Oslo, Norway.
Servicio de Gastroenterologia, Instituto Portugues de Oncologia Francisco Gentil, Porto, Portugal.
Northern Institute for Cancer Research, Newcastle University, Newcastle, United Kingdom.
Digestive Endoscopy and Gastroenterology Unit, Poliambulanza Foundation, Brescia, Italy.
Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, United Kingdom.
Department of Gastroenterology and Hepatology. University Hospital Leuven, Leuven, Belgium.
Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK.


The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). We recommend that endoscopy services across Europe adopt the following seven key and one minor performance measures for EUS and ERCP, for measurement and evaluation in daily practice at center and endoscopist level: 1: Adequate antibiotic prophylaxis before ERCP (key performance measure, at least 90 %); 2: Antibiotic prophylaxis before EUS-guided puncture of cystic lesions (key performance measure, at least 95 %); 3: Bile duct cannulation rate (key performance measure, at least 90 %); 4: Tissue sampling during EUS (key performance measure, at least 85 %); 5: Appropriate stent placement in patients with biliary obstruction below the hilum (key performance measure, at least 95 %); 6: Bile duct stone extraction (key performance measure, at least 90 %); 7: Post-ERCP pancreatitis (key performance measure, less than 10 %). 8: Adequate documentation of EUS landmarks (minor performance measure, at least 90 %).This present list of quality performance measures for ERCP and EUS recommended by ESGE should not be considered to be exhaustive: it might be extended in future to address further clinical and scientific issues.

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Conflict of interest statement

C. Bennett owns and works for Systematic Research Ltd, and received a consultancy fee from ESGE to provide scientific, technical, and methodological expertise for the present project (2014 – 2018). R. Bisschops has received speaker’s fees from Covidien (2009 – 2014) and Fujifilm (2013); speaker’s fee and hands-on training sponsorship from Olympus Europe (2013 – 2014); speaker’s fee and research support from Pentax Europe; and an editorial fee from Georg Thieme Verlag as co-editor of Endoscopy. M. Bretthauer receives fees as a member of the Norwegian Government colorectal cancer screening advisory group (2012 to present) and receives fees from the American College of Physicians for editorial work for Annals of Internal Medicine. M. Dinis-Ribeiro receives fees from Georg Thieme Verlag for editorial work for Endoscopy. M. Kaminski receives speaker’s and teaching fees and travel support from Olympus Erbe. T. Ponchon receives funds for clinical research from Boston Scientific and Fujifilm; and workshop fees from Olympus. C. Senore’s department received PillCam2 Colon devices from Medtronics (2014 – 2017) for a comparative study; together with C. Belissario and S. Minozzi he received a consultancy fee from ESGE to provide methodological expertise (PICOs evaluation, literature searches, and evidence summaries) for the present project (2014 – 2017). R. Valori is a director of AnderVal Ltd, a company providing endoscopy skills training (2015 to present). L. Aabakken, L. Czakó, D. Domagk, T. Gyökeres, C. Hassan, G. Manes, P.N. Meier, K. Oppong, J.-W. Poley, C. J. Rees, M. Rutter, C. Spada, and A. Tringali have no competing interests.

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