Still a long way to go in ERCP training: a pooled analysis of two large, prospective, multicenter studies on ERCP training practices and outcomes

Aims A paradigm shift in ERCP training has been recently advocated, with a focus on competence-based training to ensure adequate milestones are met by all trainees. We aimed to characterize real-life practices and degree of trainee exposure to hands-on training in ERCP.

Methods We conducted a post-hoc analysis of two large, prospective, international, multicenter cohort studies of training in ERCP. The main outcome variables were trainee exposure (percentage and degree of trainee involvement, including the relevant clinical characteristics of the training procedures) and impact of training on procedure and patient-related outcomes.

Results The analysis included 30 trainees and 21 trainers from 8 training centers in 6 European countries who performed a total of 3126 ERCPs over a total of 48 months. 1231 (39.4%) ERCPs had a variable degree of trainee involvement, including 611 (49.6%) independently completed by the trainee, with a median number of ERCPs per trainee of 30 (range 1-198) and significant differences in trainee involvement between centers (p<0.001). In the training group, the most common ERCP indication was bile duct stones (50.8%). However, only 45.5% of patients had a native papilla and 19.5% procedures were grade II or III (modified Schutz scale). There were no differences in technical success rates and safety outcomes between procedures with and without trainee involvement, excepting precut rates (Table 1).

Table 1 Comparison of technical and safety outcomes in procedures with and without trainee involvement.

Conclusions Our data points to a significant variability in training practices across Europe, with a relatively limited trainee hands-on involvement in ERCPs and no deleterious impact on technical success or safety. Training opportunities might be limited by the caseload mix, including many complex cases (grade II/III) and/or a prior history of endoscopic therapy [1].

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• 1 Voiosu T, Boskoski I, Voiosu AM. et al. Impact of trainee involvement on the outcome of ERCP procedures: results of a prospective multicenter observational trial. Endoscopy 2020; 52 (02) 115-122

Publication History

Article published online:
14 April 2023