Editor,—The leading article “ERCP training —time for change” by Hellier and Morris ((2000) Gut 47:459–60.OpenUrlFREE Full Text) addresses important issues. Views as to how endoscopic retrograde cholangiopancreatography (ERCP) training should change may vary considerably between those in the average district general hospital (DGH) serving 220 000–250 000, and those in larger units, frequently serving populations of around 500 000.

Firstly, those without ERCP training but additional skills elsewhere will soon find themselves a favoured species. What price a skilled ultrasonographer? Advertising recently for a third consultant gastroenterologist to join two who undertook ERCP, we specified that ERCP was a skill not required. We felt an additional …