Guideline on training and credentialing in endoscopic retrograde cholangiopancreatography.

The aim of the Endoscopic Retrograde Cholangiopancreatography (ERCP) Working Group was to examine the issues of training, credentialing and quality control in ERCP in Singapore. Published guidelines and clinical trials concerning issues of training, complications and quality control in ERCP have been reviewed. The Working Group recommended that a trainee reach a minimum threshold of 200 cases before the assessment of competency. The target for achievement of competency was set at an 85 percent successful cannulation rate for native papilla. To perform advanced ERCP, endoscopists should have undergone dedicated training either in a recognised training centre or in conjunction with and under the guidance of a more experienced colleague, until technical competency is achieved. Precut should only be performed by endoscopists with experience and expertise in performing Levels II and III ERCP, who have been formally proctored. An audit of ERCP should examine parameters such as appropriate indication, success rates of selective cannulation, technical success rate of commonly performed procedures and procedure-related complications. To maintain technical competency, an individual should be performing ERCP on a regular basis. In conclusion, the innate risks of ERCP necessitate that all ERCP practitioners should be appropriately trained, practise within their expertise level and maintain regular practice in order to minimise risks and improve patient outcome.