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Endoscopic retrograde cholangiopancreatography training conditions, results from a pan-European survey: Between vision and reality

Hamesch K 1 , Cahyadi O 2 , Dimitriadis S 2 , Hollenbach M 2 , Acedo P 3 , Ayari M 4 Show all authors , Dauvarte H 5 , Dieninyte E 6 , Domislovic V 7 , Dugic A 8 , Ďuriček M 9 , Elshaarawy O 10 , Fennessy A 11 , Geissler ME 2 , Gorcheva Z 12 , Hadi A 13 , Hamza V 14 , Hasukić I 15 , Heinrich H 16 , Levink IJM 17 , Kral J 18 , Kunovsky L 19 , Mandorfer M 20 , Moris M 21 , Nikiforova Y 22 , Ouaya H 23 , Pellino G 24 , Pisani A 25 , Qejvani O 26 , Sadigov H 27 , Salaga M 28 , Sidiropoulos O 29 , Simsek C 30 , Sousa P 31 , Stojkovic Lalosevic M 32 , Straume Z 33 , Tepes K 34 , Voiosu A 35 , Wauters L 36 , Zanetto A 37 , Schlosser S 2 , Staudacher JJ 2

Affiliations 

  • 1 Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
  • 2 Junge Gastroenterologie (JuGa) - German Young Gastroenterology Study Group of the DGVS - German Society for Digestive and Metabolic Diseases, Berlin, Germany
  • 3 Division of Medicine, Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, UK
  • 4 Gastroenterology and Hepatology Department, Internal Security Forces Hospital La Marsa, Tunis, Tunisia
  • 5 Department of Gastroenterology, East Tallinn Central Hospital, Tallinn, Estonia
  • 6 Vilnius University Hospital Santara Clinics, Vilnius, Lithuania
  • 7 Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
  • 8 Department of Medicine IV, Heidelberg University Hospital, Heidelberg, Germany
  • 9 Clinic of Internal Medicine - Gastroenterology JFM CU, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
  • 10 Institute of Systems, Molecular and Integrative Biology, Liverpool University, Liverpool, UK
  • 11 Department of Gastroenterology, St Vincent's University Hospital, Dublin, Ireland
  • 12 Department of Internal Medicine, University Hospital Sveta Marina Pleven, Medical University Pleven, Pleven, Bulgaria
  • 13 Pancreatitis Centre East (PACE), Gastrounit, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
  • 14 Gastroenterology Clinic, University Clinical Center of Kosova, Prishtine, Kosova
  • 15 Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
  • 16 Department of Gastroenterology and Hepatology, Clarunis Universitäres Bauchzentrum, Universitätsspital Basel, Basel, Switzerland
  • 17 Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  • 18 Hepatogastroenterology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
  • 19 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
  • 20 Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
  • 21 Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
  • 22 Department of the Study of Digestive System Diseases and their Comorbidity with Non-communicable Diseases, L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
  • 23 Faculty of Medicine and Pharmacy, University Hospital Mohamed VI of Tangier, Tangier, Morocco
  • 24 Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
  • 25 Division of Gastroenterology, Department of Medicine, Mater Dei Hospital, Msida, Malta
  • 26 Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Center Mother Theresa, Tirana, Albania
  • 27 Department of Gastroenterology, Azerbaijan Medical University, Baku, Azerbaijan
  • 28 Department of Biochemistry, Medical University of Lodz, Lodz, Poland
  • 29 Department of Gastroenterology, NIMTS Hospital, Athens, Greece
  • 30 Department of Gastroenterology and Hepatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
  • 31 Gastroenterology Department, Hospital São Teotónio, ULS Viseu Dão-Lafões, Viseu, Portugal
  • 32 University Clinical Center of Serbia, Belgrade, Serbia
  • 33 Gastroenterology, Hepatology and Nutrition Clinic, Riga East Clinical University Hospital, Riga, Latvia
  • 34 Department of Gastroenterology, Diagnostic Center Rogaska, Rogaška Slatina, Slovenia
  • 35 Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
  • 36 Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
  • 37 Gastroenterology and Multivisceral Transplant Unit, Padova University Hospital, Padova, Italy
United European Gastroenterol J, 2024 Nov 27.
PMID: 39601382 DOI: 10.1002/ueg2.12684

Abstract

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) still has a relatively high complication rate, underscoring the importance of high-quality training. Despite existing guidelines, real-world data on training conditions remain limited. This pan-European survey aims to systematically explore the perceptions surrounding ERCP training.

METHODS: A survey was distributed through the friends of United European Gastroenterology (UEG) Young Talent Group network to physicians working in a UEG member or associated states who regularly performed ERCPs.

RESULTS: Of 1035 respondents from 35 countries, 649 were eligible for analysis: 228 trainees, 225 trainers, and 196 individuals who regularly performed ERCP but were neither trainees nor trainers. The mean age was 43 years, with 72.1% identifying as male, 27.6% as female, and 0.3% as non-binary. The majority (80.1%) agreed that a structured training regimen is desirable. However, only 13.7% of trainees and 28.4% of trainers reported having such a structured program in their institutions. Most respondents (79.7%) supported the concept of concentrating training in centers meeting specific quality metrics, with 64.1% suggesting a threshold of 200 annual ERCPs as a prerequisite. This threshold revealed that 36.4% of trainees pursued training in lower-volume centers performing <200 ERCPs annually. As many as 70.1% of trainees performed <50 annual ERCPs, whereas only 5.0% of trainers performed <50 ERCPs annually. A low individual trainee caseload (<50 ERCPs annually) was more common in lower-volume centers than in higher-volume centers (82.9% vs. 63.4%).

CONCLUSIONS: The first pan-European survey investigating ERCP training conditions reveals strong support for structured training and the concentration of training efforts within centers meeting specific quality metrics. Furthermore, this survey exposes the low availability of structured training programs with many trainees practicing at lower-volume centers and 71% of all trainees having little hands-on exposure. These data should motivate to standardize ERCP training conditions further and ultimately improve patient care throughout Europe.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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