ERCP: present practice in a single region. Suggested standards for monitoring performance.

A survey of consecutive endoscopic retrograde cholangiopancreatography (ERCP) procedures has been undertaken for all the Units performing this procedure in the (old) Northern region of the UK. The process, imaging success, procedural success and complications have been analysed for 255 ERCP procedures. Overall, the results seem to be reassuring, with an imaging success rate of 88% (n = 297 ducts required), additional procedural success rate of 88% (n = 178) and with a serious complication rate of 6%. However, there are wide differences both in terms of practice (contrast agent used, antibody prophylaxis), imaging success (76-95%) and outcomes (procedure success 75-100%, serious complications 0-16%). This wide difference in practice seems difficult to justify. Individual Units should monitor their performance. Standards of practice are suggested for discussion and debate.