UK Joint Advisory Group consensus statements for training and certification in endoscopic retrograde cholangiopancreatography

Keith Siau; Margaret G Keane; Helen Steed; Grant Caddy; Nick Church; Harry Martin; Raymond McCrudden; Peter Neville; Kofi Oppong; Bharat Paranandi; Ashraf Rasheed; Richard Sturgess; Neil D Hawkes; George Webster; Gavin Johnson; on behalf of the Joint Advisory Group on Gastrointestinal Endoscopy (JAG)

doi:10.1055/a-1629-7540

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(01): E37-E49
DOI: 10.1055/a-1629-7540

Original article

UK Joint Advisory Group consensus statements for training and certification in endoscopic retrograde cholangiopancreatography

Authors

Keith Siau

¹Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK

²Medical and Dental Sciences, University of Birmingham, Birmingham, UK
Margaret G Keane

³Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
Helen Steed

⁴Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK

⁵Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
Grant Caddy

⁶Department of Gastroenterology, South Eastern Health and Social Care Trust, Northern Ireland, UK
Nick Church

⁷Department of Gastroenterology, NHS Lothian, Edinburgh, Scotland
Harry Martin

⁸Department of Gastroenterology, University College London Hospitals, London, UK
Raymond McCrudden

⁹Department of Gastroenterology, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
Peter Neville

¹⁰Department of Gastroenterology, Cwm Taf Morgannwg Health Board, Merthyr Tydfil, UK
Kofi Oppong

¹¹Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
Bharat Paranandi

¹²Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
Ashraf Rasheed

¹³Department of Surgery, Aneurin Bevan University Health Board, Newport, UK
Richard Sturgess

¹⁴Department of Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
Neil D Hawkes

¹⁰Department of Gastroenterology, Cwm Taf Morgannwg Health Board, Merthyr Tydfil, UK
George Webster

⁸Department of Gastroenterology, University College London Hospitals, London, UK
Gavin Johnson

⁸Department of Gastroenterology, University College London Hospitals, London, UK

on behalf of the Joint Advisory Group on Gastrointestinal Endoscopy (JAG)

Abstract

Background and study aims Despite the high-risk nature of endoscopic retrograde cholangiopancreatography (ERCP), a robust and standardized credentialing process to ensure competency before independent practice is lacking worldwide. On behalf of the Joint Advisory Group (JAG), we aimed to develop evidence-based recommendations to form the framework of ERCP training and certification in the UK.

Methods Under the oversight of the JAG, a modified Delphi process was conducted with stakeholder representation from the British Society of Gastroenterology, Association of Upper Gastrointestinal Surgeons, trainees and trainers. Recommendations on ERCP training and certification were formulated after formal literature review and appraised using the GRADE tool. These were subjected to electronic voting to achieve consensus. Accepted statements were peer-reviewed by JAG and relevant Specialist Advisory Committees before incorporation into the ERCP certification pathway.

Results In total, 27 recommendation statements were generated for the following domains: definition of competence (9 statements), acquisition of competence (8 statements), assessment of competence (6 statements) and post-certification support (4 statements). The consensus process led to the following criteria for ERCP certification: 1) performing ≥ 300 hands-on procedures; 2) attending a JAG-accredited ERCP skills course; 3) in modified Schutz 1–2 procedures: achieving native papilla cannulation rate ≥80%, complete bile duct clearance ≥ 70 %, successful stenting of distal biliary strictures ≥ 75 %, physically unassisted in ≥ 80 % of cases; 4) 30-day post-ERCP pancreatitis rates ≤5 %; and 5) satisfactory performance in formative and summative direct observation of procedural skills (DOPS) assessments.

Conclusions JAG certification in ERCP has been developed following evidence-based consensus to quality assure training and to ultimately improve future standards of ERCP practice.

Full Text

References

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