Associate Editor, Douglas Adler, MD, highlights this article from the June issue of GIE–“When trainees reach competency in performing ERCP: a systematic review” by Drs Neal Shahidi, George Ou, Jennifer Telford, and Robert Enns.
The article critically assesses papers that have looked at ERCP training and outcomes and shows that the more rigorously you define success in ERCP the longer it takes to achieve competency. The article supports the notion that just doing a lot of ERCPs is insufficient for establishing competency, but rather the successful completion of specific maneuvers (i.e., cannulation in a patient with a native papilla) are better benchmarks to evaluate.
As someone intensely interested in ERCP and training in ERCP (and the author of one of the studies included in the systematic review), I think this paper is vitally important. ERCP remains the most complex and most high-risk procedure in GI endoscopy, and we need to ensure that we are adequately training young practitioners who plan to perform ERCP independently.
As a take-home point, participating (to varying extents) in 100-200 ERCPs as a fellow probably does not make you competent to perform ERCP independently.
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