Stricter national standards are required for credentialing of endoscopic-retrograde-cholangiopancreatography in the United States

Table 2 Core Curriculum for endoscopic-retrograde-cholangiopancreatography trainees

Cognitive
1 Obtain written, witnessed, and informed patient consent with discussion of the indication for the ERCP; potential complications including pancreatitis, hemorrhage, duct leak, perforation and infection; alternative tests or therapies; and adequately answer patient questions
2 Realize appropriate indications for ERCP and accessory interventions
3 Evaluate patient prior to procedure and optimize outcomes, in terms of potential bleeding (i.e., hold antiplatelet and anticoagulants if possible), and administer antibiotics as necessary to prevent subsequent sepsis
4 Understand and practice prophylactic interventions, especially to prevent post-ERCP pancreatitis
5 Know “best practice” recommendations as to technical approaches during ERCP
6 Knowledge of optimal management of ERCP complications
7 Manage the patient after ERCP as in-patient or outpatient, as appropriate
8 Manage complications occurring during or after ERCP
9 Knowledgeably discuss findings and consult with allied specialists: hepatobiliary or pancreatic surgeons and interventional radiologists
Technical (not comprehensive)
1 Evaluate ampulla in a knowledgeable fashion
2 Access necessary ductal system via deep cannulation ≥ 90% attempts
3 Procure required fluoroscopic images of the biliary and pancreatic ductal systems
4 Working knowledge to interpret fluoroscopic images
5 Perform optimal biliary and/or pancreatic sphincterotomy as required
6 Extract biliary and pancreatic duct stones via basket or balloon.
7 Insert plastic and metal stents into pancreatic and biliary system as required
8 Perform intraductal endoscopy and associated diagnostic or therapeutic maneuvers, as required: EHL, laser, biopsies, and brushings

Adopted with major modifications from Jorgensen et al[23]. ERCP: Endoscopic retrograde cholangiopancreatography; EHL: electrohydraulic lithotripsy.