Curriculum for ERCP and endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Abstract

Main RecommendationsThe European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in ERCP and EUS. This curriculum is set out in terms of the prerequisites prior to training; recommended steps of training to a defined syllabus; the quality of training; and how competence should be defined and evidenced before independent practice. 1 Trainees should be competent in gastroscopy prior to commencing training. Formal training courses and the use of simulation in training are recommended. 2 Trainees should keep a contemporaneous logbook of their procedures, including key performance indicators and the degree of independence. Structured formative assessment is encouraged to enhance feedback. There should be a summative assessment process prior to commencing independent practice to ensure there is robust evidence of competence. This evidence should include a review of a trainee’s procedure volume and current performance measures. A period of mentoring is strongly recommended in the early stages of independent practice. 3 Specifically for ERCP, all trainees should be competent up to Schutz level 2 complexity (management of distal biliary strictures and stones > 10 mm), with advanced ERCP requiring a further period of training. Prior to independent practice, ESGE recommends that a trainee can evidence a procedure volume of > 300 cases, a native papilla cannulation rate of ≥ 80 % (90 % after a period of mentored independent practice), complete stones clearance of ≥ 85 %, and successful stenting of distal biliary strictures of ≥ 90 % (90 % and 95 % respectively after a mentored period of independent practice). 4 The progression of EUS training and competence attainment should start from diagnostic EUS and then proceed to basic therapeutic EUS, and finally to advanced therapeutic EUS. Before independent practice, ESGE recommends that a trainee can evidence a procedure volume of > 250 cases (75 fine-needle aspirations/biopsies [FNA/FNBs]), satisfactory visualization of key anatomical landmarks in ≥ 90 % of cases, and an FNA/FNB accuracy rate of ≥ 85 %. ESGE recognizes the often inadequate quality of the evidence and the need for further studies pertaining to training in advanced endoscopy, particularly in relation to therapeutic EUS.

In difficult biliary cannulation, how quickly should we be reaching for the second wire?

“…in the Maharshi and Sharma study. These both comfortably exceed the European Society of Gastrointestinal Endoscopy key performance indictor of successful bile duct cannulation of more than 90 % 3 . However, a paper by Ekkelenkamp et al looked at procedural success rate for ERCP on a national level.…”

EUS and ERCP in the Same Session for Biliary Stones: From Risk Stratification to Treatment Strategy in Different Clinical Conditions

“…Given the complexity of both EUS and ERCP, the European Society of Gastrointestinal Endoscopy (ESGE) has identified quality in endoscopy as a top priority [ 10 ]. Unfortunately, many countries still lack specific guidance for high-quality training in the art of bilio-pancreatic endoscopy [ 11 ].…”

Accountability in EUS: Is it possible?

“…In other words, when an endoscopist reaches the standards defined in the training phase, it is not the end of the learning, but merely a platform at which independent practice can commence. [ 3 ]…”

“…The European Society of Gastrointestinal Endoscopy has indicated that a more experienced colleague mentors endoscopists starting to practice independently for at least 6 months, particularly for challenging cases. [ 3 ] Small-volume centers that work together as a network are capable of performing comparably to high-volume centers. For this reason, new EUS programs should remain in a EUS network that has the potential to fulfill the desired service provision outlined by the British Society of Gastroenterology.…”