P49 The national performance in the management of common bile duct stones in England

Aims Bile Duct Stones (BDS) is a common indication for ERCP. There are British Society of Gastroenterology endorsed national standards for clearance rates with the expectation that 75% or more of initial ERCPs for BDS should result in stone clearance.1 This paper will examine the NHS data set from all trusts in England to assess the treatment of BDS. Methods Using ICD-10 codes defined by an accredited clinical coder we examined the Hospital Episode Statistics (HES) data from all of England from 2013/4 to 2018/9 and selected those who had their initial bile duct stones presentations in 2015/6 to 2016/7, which excluded those identified in the previous 2 years. We followed this cohort of patients throughout the period of time from their presentation to the end of 2019 financial year and assessed how many ERCPs each patient underwent. We therefore had 2 years of patients with a primary diagnosis of bile duct stones with at least 2 years of follow up. All data has been limited to NHS hospitals. Results Over the 4 year follow up period 86,602 of the 183,503 ERCPs (47.2%) done were for BDS. The 2015/6 to 2016/7 cohort was made of 37,468 patients who needed 55,556 ERCPs. 26,146 had only 1 ERCP, which, at best, represents a BDS clearance rate at first ERCP of 69.8%. In addition, the remaining 11,322 (30.2%) patients required 29,410 ERCPs, demonstrating that 52.9% of ERCPs undertaken for those who had an initial BDS presentation between 2015/16 and 2016/17 were repeat procedures. This is shown in graph 1. The cumulative BDS clearance rate of 1, 2 and 3 ERCPS is, at best, 69.8%, 89.7% and 95.9%. The BSG key performance indicator states that 75% of BDS should be cleared at first ERCP. There are 32/154 (20.8%) hospital trusts/groups where less than 75% of those who presented with BDS needed only 1 ERCP. There are 2 (1.3%) trusts/groups where less than 50% of patients needed only 1 ERCP. From our data there appears to be little correlation between number of ERCPs for BDS performed by trust and BDS clearance. There is significant regional as well as trusts/groups variation in those needing more than 1 ERCP for BDS. Conclusions We are falling below the minimum standards required for stone clearance at ERCP, leading to findings that, in England, more than 50% of ERCPs for BDS are repeat procedures. The reasons for this require further study but the extra burden of cost on the NHS is significant. Reference ERCP – The Way Forward, A Standards Framework. ERCP Workign Party [Internet]. Available from: https://www.bsg.org.uk/resource/ercp-the-way-forward-a-standards-framework-pdf.html