Introduction ERCP services have traditionally developed dependent on local facilities and expertise. Recognising concerns regarding ERCP training and service provision, there have been efforts to describe the features of a high quality ERCP service and training program. Greater procedural volume leads to improved outcomes but there is no consensus on the effect this has on current ERCP service and training structure. We have reviewed how current regional practice fits into a suggested optimal service model and how training fits within this.
Methods All ERCP endoscopists and trainees within the NorthWestern deanery were invited to complete an electronic survey of their routine practice.
Results All 29 ERCP endoscopists, and 35 (79.5%) trainees, from 12 hospitals responded.
All units fulfilled criteria for a high quality service with access to multidisciplinary meetings and interventional radiology facilities and audit protocol. However, there was no standard approach to assessment or management of common diagnoses. Half were confident that CBD stones <10 mm would be removed in greater than 95% of occasions. Increased confidence was seen in higher volume operators. Pancreatitis prophylaxis (rectal NSAID or prophylactic pancreatic stenting) was not universally used, but more likely to be utilised by high volume operators.
7 of 9 units offering ERCP training provided training in the previous 12 months but there was no standardised approach, and no structure to allow exposure to higher case volume and complexity as training progressed. 54.2% of trainees declared an interest in ERCP training, with 37.1% currently training. All trainees had encountered difficulty obtaining training. 87.5% did not expect to be competent at CCT.
Conclusion The current structure of this regional ERCP service fulfils suggested criteria for high quality service. This demonstrates that the current endoscopists are working with sufficient volume of cases to maintain expertise, and also have access to services to ensure appropriate and safe patient selection.
However, there is no organisation of training. A high proportion of trainees are receiving limited training, and there is universal concern regarding availability.
To optimise training within the region, we suggest that trainee numbers should be limited and a standardised training program developed. This would allow effective monitoring of training progression with the aim of producing a cohort of endoscopists who are near to or at a level of competence at the time of their CCT to start independent practice as a consultant or continue supervised practice as a post CCT fellow.
Disclosure of Interest None Declared