BACKGROUND AND AIMS: ERCP is an advanced endoscopic procedure that is technically more challenging and carries a higher risk of adverse events compared with standard endoscopy. A discrepancy currently exists among guidelines regarding the number of ERCPs that a trainee needs to complete before procedural competency should be assessed. Our aim was to assess the learning curve for performing ERCP. METHODS: Two authors independently searched MEDLINE (1946 to November 25, 2014) along with the gray literature to identify relevant citations. To warrant inclusion, citations were required to report successful trainee cannulation rate. Successful cannulation rate, set at a value of 80% or higher, was used as our baseline reference for competency. RESULTS: Nine studies, assessing 137 trainees and 17,100 ERCPs, were included in our analysis. Overall, competency was achieved among the included studies between 70 to 400 ERCPs. In the 2 studies that used pancreatic duct cannulation rate, competency was achieved by 70 to 160 ERCPs. Of the 5 studies that used selective duct cannulation rate, competency was achieved by 79 to 300 ERCPs. Finally, in the 4 studies that used common bile duct cannulation rate, 2 studies reached the reference competency threshold by 160 to 400 ERCPs. On further stratification, when assessing native papilla deep common bile duct cannulation, only 1 study reached the reference competency threshold by 350 to 400 ERCPs. CONCLUSIONS: Our findings suggest that as ERCP has evolved from a predominantly diagnostic to therapeutic procedure, procedural thresholds have risen well above North American training guidelines. Therefore, advanced endoscopy training programs need to reassess their current structure to ensure that procedural competency is being reached.
BACKGROUND AND AIMS: ERCP is an advanced endoscopic procedure that is technically more challenging and carries a higher risk of adverse events compared with standard endoscopy. A discrepancy currently exists among guidelines regarding the number of ERCPs that a trainee needs to complete before procedural competency should be assessed. Our aim was to assess the learning curve for performing ERCP. METHODS: Two authors independently searched MEDLINE (1946 to November 25, 2014) along with the gray literature to identify relevant citations. To warrant inclusion, citations were required to report successful trainee cannulation rate. Successful cannulation rate, set at a value of 80% or higher, was used as our baseline reference for competency. RESULTS: Nine studies, assessing 137 trainees and 17,100 ERCPs, were included in our analysis. Overall, competency was achieved among the included studies between 70 to 400 ERCPs. In the 2 studies that used pancreatic duct cannulation rate, competency was achieved by 70 to 160 ERCPs. Of the 5 studies that used selective duct cannulation rate, competency was achieved by 79 to 300 ERCPs. Finally, in the 4 studies that used common bile duct cannulation rate, 2 studies reached the reference competency threshold by 160 to 400 ERCPs. On further stratification, when assessing native papilla deep common bile duct cannulation, only 1 study reached the reference competency threshold by 350 to 400 ERCPs. CONCLUSIONS: Our findings suggest that as ERCP has evolved from a predominantly diagnostic to therapeutic procedure, procedural thresholds have risen well above North American training guidelines. Therefore, advanced endoscopy training programs need to reassess their current structure to ensure that procedural competency is being reached.
Authors: Theodor Voiosu; Paul Bălănescu; Andrei Voiosu; Andreea Benguş; Carmen Preda; Devica S Umans; Radu Bogdan Mateescu; Jeanin E van Hooft Journal: United European Gastroenterol J Date: 2018-11-28 Impact factor: 4.623
Authors: Mazen R Al-Mansour; Eleanor C Fung; Edward L Jones; Nichole E Zayan; Timothy D Wetzel; Sara E Martin Del Campo; Anahita D Jalilvand; Andrew J Suzo; Rebecca R Dettorre; James K Fullerton; Michael P Meara; John D Mellinger; Vimal K Narula; Jeffrey W Hazey Journal: Surg Endosc Date: 2017-12-22 Impact factor: 4.584
Authors: Sachin Wani; Samuel Han; Violette Simon; Matthew Hall; Dayna Early; Eva Aagaard; Wasif M Abidi; Subhas Banerjee; Todd H Baron; Michael Bartel; Erik Bowman; Brian C Brauer; Jonathan M Buscaglia; Linda Carlin; Amitabh Chak; Hemant Chatrath; Abhishek Choudhary; Bradley Confer; Gregory A Coté; Koushik K Das; Christopher J DiMaio; Andrew M Dries; Steven A Edmundowicz; Abdul Hamid El Chafic; Ihab El Hajj; Swan Ellert; Jason Ferreira; Anthony Gamboa; Ian S Gan; Lisa Gangarosa; Bhargava Gannavarapu; Stuart R Gordon; Nalini M Guda; Hazem T Hammad; Cynthia Harris; Sujai Jalaj; Paul Jowell; Sana Kenshil; Jason Klapman; Michael L Kochman; Sri Komanduri; Gabriel Lang; Linda S Lee; David E Loren; Frank J Lukens; Daniel Mullady; Raman V Muthusamy; Andrew S Nett; Mojtaba S Olyaee; Kavous Pakseresht; Pranith Perera; Patrick Pfau; Cyrus Piraka; John M Poneros; Amit Rastogi; Anthony Razzak; Brian Riff; Shreyas Saligram; James M Scheiman; Isaiah Schuster; Raj J Shah; Rishi Sharma; Joshua P Spaete; Ajaypal Singh; Muhammad Sohail; Jayaprakash Sreenarasimhaiah; Tyler Stevens; James H Tabibian; Demetrios Tzimas; Dushant S Uppal; Shiro Urayama; Domenico Vitterbo; Andrew Y Wang; Wahid Wassef; Patrick Yachimski; Sergio Zepeda-Gomez; Tobias Zuchelli; Rajesh N Keswani Journal: Gastrointest Endosc Date: 2019-02-07 Impact factor: 9.427
Authors: Sachin Wani; Rajesh Keswani; Matt Hall; Samuel Han; Meer Akbar Ali; Brian Brauer; Linda Carlin; Amitabh Chak; Dan Collins; Gregory A Cote; David L Diehl; Christopher J DiMaio; Andrew Dries; Ihab El-Hajj; Swan Ellert; Kimberley Fairley; Ashley Faulx; Larissa Fujii-Lau; Srinivas Gaddam; Seng-Ian Gan; Jonathan P Gaspar; Chitiki Gautamy; Stuart Gordon; Cynthia Harris; Sarah Hyder; Ross Jones; Stephen Kim; Srinadh Komanduri; Ryan Law; Linda Lee; Rawad Mounzer; Daniel Mullady; V Raman Muthusamy; Mojtaba Olyaee; Patrick Pfau; Shreyas Saligram; Cyrus Piraka; Amit Rastogi; Laura Rosenkranz; Fadi Rzouq; Aditi Saxena; Raj J Shah; Violette C Simon; Aaron Small; Jayaprakash Sreenarasimhaiah; Andrew Walker; Andrew Y Wang; Rabindra R Watson; Robert H Wilson; Patrick Yachimski; Dennis Yang; Steven Edmundowicz; Dayna S Early Journal: Clin Gastroenterol Hepatol Date: 2017-06-16 Impact factor: 11.382
Authors: Rena Yadlapati; Rajesh N Keswani; Jody D Ciolino; David P Grande; Zoe I Listernick; Dustin A Carlson; Donald O Castell; Kerry B Dunbar; Andrew J Gawron; C Prakash Gyawali; Philip O Katz; David Katzka; Brian E Lacy; Stuart J Spechler; Roger Tatum; Marcelo F Vela; John E Pandolfino Journal: Clin Gastroenterol Hepatol Date: 2016-07-27 Impact factor: 11.382