Between Vision and Reality: Results From A Pan-European Survey on Endoscopic Retrograde Cholangiopancreatography Training Conditions

Aims Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure associated with a relevant risk of complications underscoring the importance of high-quality training. Despite existing guidelines, real-world data regarding ERCP training conditions and adherence to these recommendations remain limited. This Pan-European survey aims to explore the perceptions surrounding ERCP training conditions.

Methods A survey was distributed through the friends of the Young United European Gastroenterologists (UEG) Talent Group network. Inclusion criteria were physicians working in a UEG member state and regularly performing ERCP. Likert-scales as well as single- and multiple-choice questions were utilized.

Results In total, 649 out of 1035 respondents were eligible for analysis. Participants were based in 39 countries. 228 were identified as trainees, 225 as trainers, and 196 regularly performed ERCP without being in either category. The mean age was 40 years (IQR 36 to 48) with 72.0%, 27.6%, and 0.3% identifying as male, female, and non-binary, respectively. Eighty percent of respondents found that a structured training regimen to be desirable or very desirable. However, only 14% of trainees and 28% of trainers reported having such a structured program in their institutions. Mandatory self-assessment was reported only by 6% of trainees and 11% of trainers. Majority of trainees (75%) and trainers (86%) agreed or strongly agreed that training should be concentrated within centers meeting certain quality metrics. Concerning procedure volume as a quality metric, 78% indicated that a threshold of 200 annual ERCPs should be used. Nevertheless, 30% of trainees pursued training in centers with<200 annual ERCPs. Regarding number of annual procedures, 95% of trainers reported performing>50 ERCPs, in stark contrast with 71% of trainees performing<50 ERCPs. Dividing centers into low and high volume (cut-off: 200 ERCPs/year) revealed that a low annual procedure volume of<50 was more frequent at lower volume centers vs. higher volume centers (86% vs. 63%, respectively).

Conclusions While structured training and concentration of training efforts within European centers meeting specific quality metrics are desirable, the survey exposed the low availability of structured training programs and that around 30% of trainees are practicing at low-volume centers. These data could be interpreted as motivation to further improve ERCP training conditions and ultimately patient care throughout Europe.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024