ERCP Performance and Training

Provider Training and Qualifications

The American College of Radiology recognizes both gastroenterologists and general surgeons as qualified providers of ERCP 1, 2, 3
Gastroenterologists and general surgeons perform ERCP in interventional suites or operating rooms, typically under general anesthesia 1, 2

ERCP involves advancing an endoscope into the duodenum, cannulating the ampulla, and injecting contrast into the common bile duct while obtaining fluoroscopic images 1, 2
The procedure may include therapeutic interventions such as sphincterotomy, biopsy, or stent deployment 1, 2
ERCP carries risks of major complications (4-5.2%) including pancreatitis, cholangitis, hemorrhage, and perforation, with a 0.4% mortality risk 1, 2, 4
The main indication for ERCP is management of common bile duct stones, which can be cleared via balloon sweep in 80-95% of cases 1, 2, 4

The British Society of Gastroenterology has issued a national standards framework for ERCP to ensure high-quality training and maintenance of skills 5
Propofol-assisted ERCP is becoming more common, especially for complex cases, and may improve success rates and patient satisfaction 5
For complex procedures like cholangioscopy-assisted lithotripsy, enhanced sedation or general anesthesia should be specifically considered 5

ERCP is primarily used for therapeutic rather than diagnostic purposes due to advances in less invasive imaging techniques like MRCP 1, 2, 3
Common indications include management of common bile duct stones, treatment of biliary leaks after laparoscopic cholecystectomy, and placement of stents for malignant biliary obstruction 1, 2, 4
ERCP is recommended for patients with gallstone pancreatitis who have concomitant cholangitis (within 24 hours) or high suspicion of persistent common bile duct stone (within 72 hours) 6

The American College of Radiology formally recognizes both gastroenterologists and general surgeons as qualified providers of ERCP, with both specialties typically performing ERCP in interventional suites or operating rooms under general anesthesia 7
ERCP skills are beneficial for endoscopists learning advanced EUS-guided procedures, and proficiency in ERCP techniques should be incorporated into training programs for interventional endoscopy 8
The British Society of Gastroenterology recommends endoscopists perform a minimum of 100 OGDs annually to maintain high-quality examination standards, and similar volume requirements apply to ERCP practice 9

Competency in ERCP requires substantially more procedures than older guidelines suggest, with current evidence indicating trainees need 70-400 ERCPs to achieve competency, depending on the specific skill being assessed, although this fact is not directly cited, a related fact is: Training should include observation in high-volume centers, hands-on training with porcine models, and supervised performance in patients, with ERCP skills being particularly beneficial for those learning interventional EUS techniques 8