Association Between Volume of Endoscopic Retrograde Cholangiopancreatography at an Academic Medical Center and Use of Pancreatobiliary Therapy  Gregory A. Coté, Sanjeev Singh, Lois G. Bucksot, Laura Lazzell–Pannell, Suzette E. Schmidt, Evan Fogel, Lee McHenry, James Watkins, Glen Lehman, Stuart Sherman  Clinical Gastroenterology and Hepatology  Volume 10, Issue 8, Pages 920-924 (August 2012) DOI: 10.1016/j.cgh.2012.02.019 Copyright © 2012 AGA Institute Terms and Conditions

Figure 1 Change in ERCP volume at an endoscopic referral center. There is steady growth in annual volume between 1994 and 2009, with proportional growth in patients having previously undergone an ERCP, successful or failed, at another facility. A failed ERCP was defined as inability to cannulate the desired duct and/or complete required therapy (eg, stent placement across a stricture). Clinical Gastroenterology and Hepatology 2012 10, 920-924DOI: (10.1016/j.cgh.2012.02.019) Copyright © 2012 AGA Institute Terms and Conditions

Figure 2 Change in use of anesthesia-administered sedation and prevalence of American Society of Anesthesiologists (ASA) class >2. Clinical Gastroenterology and Hepatology 2012 10, 920-924DOI: (10.1016/j.cgh.2012.02.019) Copyright © 2012 AGA Institute Terms and Conditions

Figure 3 (A) Proportion of ERCPs performed for biliary indications (Schutz–Abbott grades I–II). Compared with earlier years, the proportion of cases performed for bile duct (BD) stone disease declined. On the other hand, we observed an increase in ERCPs performed for treatment of BD strictures and leaks in later years. (B) Proportion of ERCPs performed for Schutz–Abbott grades II–III indications. The proportion of ERCPs performed for the treatment of pancreas divisum declined over time. By comparison, those completed for suspected sphincter of Oddi dysfunction (SOD) and treatment of pancreatic duct (PD) stone and/or stricture increased. Clinical Gastroenterology and Hepatology 2012 10, 920-924DOI: (10.1016/j.cgh.2012.02.019) Copyright © 2012 AGA Institute Terms and Conditions

Figure 4 (A) Change in rate of selected biliary endotherapies. (B) Change in rate of selected pancreatic endotherapies. Clinical Gastroenterology and Hepatology 2012 10, 920-924DOI: (10.1016/j.cgh.2012.02.019) Copyright © 2012 AGA Institute Terms and Conditions