Curriculum for ERCP and endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Gavin Johnson; George Webster; Ivo Boškoski; Sara Campos; Stefan Karl Gölder; Christoph Schlag; Andrea Anderloni; Urban Arnelo; Abdenor Badaoui; Noor Bekkali; Dimitrios Christodoulou; László Czakó; Michael Fernandez Y Viesca; Istvan Hritz; Tomas Hucl; Evangelos Kalaitzakis; Leena Kylänpää; Ivan Nedoluzhko; Maria Chiara Petrone; Jan-Werner Poley; Andrada Seicean; Juan Vila; Marianna Arvanitakis; Mario Dinis-Ribeiro; Thierry Ponchon; Raf Bisschops

doi:10.1055/a-1537-8999

Endoscopy, Table of Contents

Endoscopy 2021; 53(10): 1071-1087
DOI: 10.1055/a-1537-8999

Position Statement

Curriculum for ERCP and endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Gavin Johnson

¹University College London Hospitals, London, UK

,

George Webster

¹University College London Hospitals, London, UK

,

Ivo Boškoski

²Gastroenterology and Digestive Endoscopy, Fondazione Policlinico Gemelli, Rome, Italy

,

Sara Campos

³Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal

,

Stefan Karl Gölder

⁴Department of Internal Medicine III, University Hospital Augsburg, Augsburg, Germany

,

Christoph Schlag

⁵Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland

,

Andrea Anderloni

⁶Division of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy

,

Urban Arnelo

⁷Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden

,

Abdenor Badaoui

⁸Department of Gastroenterology and Hepatology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium

,

Noor Bekkali

⁹John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford, UK

,

Dimitrios Christodoulou

¹⁰Department of Gastroenterology, Medical School and University Hospital of Ioannina, Ioannina, Greece

,

László Czakó

¹¹Department of Medicine, University of Szeged, Szeged, Hungary

,

Michael Fernandez Y Viesca

¹²Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium

,

Istvan Hritz

¹³Centre for Therapeutic Endoscopy, 1st Department of Surgery and Interventional Gastroenterology, Semmelweis University, Budapest, Hungary

,

Tomas Hucl

¹⁴Department of Gastroenterology and Hepatology, IKEM, Prague, Czech Republic

,

Evangelos Kalaitzakis

¹⁵Department of Gastroenterology, University Hospital of Heraklion, University of Crete, Heraklion, Greece

¹⁶Digestive Disease Center, University Hospital of Copenhagen/Herley, University of Copenhagen, Copenhagen, Denmark

,

Leena Kylänpää

¹⁷Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland

,

Ivan Nedoluzhko

¹⁸Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow, Russia

,

Maria Chiara Petrone

¹⁹Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy

,

Jan-Werner Poley

²⁰Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands

,

Andrada Seicean

²¹Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania

,

Juan Vila

²²Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IDISNA), Pamplona, Spain

,

Marianna Arvanitakis

¹²Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium

,

Mario Dinis-Ribeiro

²³Gastroenterology Department, IPO Porto, Porto, Portugal

,

Thierry Ponchon

²⁴Gastroenterology Division, Edouard Herriot Hospital, Lyon, France

,

Raf Bisschops

²⁵Department of Gastroenterology and Hepatology, University Hospitals Leuven, and TARGID, KU Leuven, Leuven, Belgium

› Author Affiliations

Abstract

Main Recommendations

The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in ERCP and EUS. This curriculum is set out in terms of the prerequisites prior to training; recommended steps of training to a defined syllabus; the quality of training; and how competence should be defined and evidenced before independent practice.

1 Trainees should be competent in gastroscopy prior to commencing training. Formal training courses and the use of simulation in training are recommended.

2 Trainees should keep a contemporaneous logbook of their procedures, including key performance indicators and the degree of independence. Structured formative assessment is encouraged to enhance feedback. There should be a summative assessment process prior to commencing independent practice to ensure there is robust evidence of competence. This evidence should include a review of a trainee’s procedure volume and current performance measures. A period of mentoring is strongly recommended in the early stages of independent practice.

3 Specifically for ERCP, all trainees should be competent up to Schutz level 2 complexity (management of distal biliary strictures and stones > 10 mm), with advanced ERCP requiring a further period of training. Prior to independent practice, ESGE recommends that a trainee can evidence a procedure volume of > 300 cases, a native papilla cannulation rate of ≥ 80 % (90 % after a period of mentored independent practice), complete stones clearance of ≥ 85 %, and successful stenting of distal biliary strictures of ≥ 90 % (90 % and 95 % respectively after a mentored period of independent practice).

4 The progression of EUS training and competence attainment should start from diagnostic EUS and then proceed to basic therapeutic EUS, and finally to advanced therapeutic EUS. Before independent practice, ESGE recommends that a trainee can evidence a procedure volume of > 250 cases (75 fine-needle aspirations/biopsies [FNA/FNBs]), satisfactory visualization of key anatomical landmarks in ≥ 90 % of cases, and an FNA/FNB accuracy rate of ≥ 85 %.

ESGE recognizes the often inadequate quality of the evidence and the need for further studies pertaining to training in advanced endoscopy, particularly in relation to therapeutic EUS.

Full Text

References

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