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
 1   University College London Hospitals, London, UK
George Webster
 1   University College London Hospitals, London, UK
 2   Gastroenterology and Digestive Endoscopy, Fondazione Policlinico Gemelli, Rome, Italy
Sara Campos
 3   Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
 4   Department of Internal Medicine III, University Hospital Augsburg, Augsburg, Germany
Christoph Schlag
 5   Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland
Andrea Anderloni
 6   Division of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
Urban Arnelo
 7   Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
Abdenor Badaoui
 8   Department of Gastroenterology and Hepatology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
Noor Bekkali
 9   John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford, UK
Dimitrios Christodoulou
10   Department of Gastroenterology, Medical School and University Hospital of Ioannina, Ioannina, Greece
László Czakó
11   Department of Medicine, University of Szeged, Szeged, Hungary
Michael Fernandez Y Viesca
12   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
Istvan Hritz
13   Centre for Therapeutic Endoscopy, 1st Department of Surgery and Interventional Gastroenterology, Semmelweis University, Budapest, Hungary
Tomas Hucl
14   Department of Gastroenterology and Hepatology, IKEM, Prague, Czech Republic
Evangelos Kalaitzakis
15   Department of Gastroenterology, University Hospital of Heraklion, University of Crete, Heraklion, Greece
16   Digestive Disease Center, University Hospital of Copenhagen/Herley, University of Copenhagen, Copenhagen, Denmark
Leena Kylänpää
17   Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland
Ivan Nedoluzhko
18   Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow, Russia
Maria Chiara Petrone
19   Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
Jan-Werner Poley
20   Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
Andrada Seicean
21   Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
22   Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IDISNA), Pamplona, Spain
Marianna Arvanitakis
12   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
Mario Dinis-Ribeiro
23   Gastroenterology Department, IPO Porto, Porto, Portugal
Thierry Ponchon
24   Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
Raf Bisschops
25   Department of Gastroenterology and Hepatology, University Hospitals Leuven, and TARGID, KU Leuven, Leuven, Belgium
› Author Affiliations

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.

Tables 1 s–5 s

Publication History

Article published online:
26 July 2021

© 2021. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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