Introduction

Pancreaticobiliary diseases, including acute and chronic pancreatitis and pancreatic cancer, are common, although there is currently no training curriculum for this subspecialty within medical gastroenterology. There is a need for medical gastroenterologists experienced in the management of these complex patients, which increasingly involves a multidisciplinary approach. For both acute and chronic pancreatitis, an aetiology should be sought and surveillance conducted for the development of complications, such as exocrine and endocrine failure, nutritional deficiencies and osteoporosis. Furthermore, some patients may require long-term support with smoking and alcohol cessation. Pancreatic cancer and cholangiocarcinoma have a poor prognosis that has not improved in recent years. Although physicians are involved in the initial diagnostic process, there are now evolving areas where they can contribute to the subsequent management. An increasing workload is the assessment and treatment of patients with cystic pancreatic lesions, detected incidentally on cross-sectional imaging. Additionally, the management of biliary disorders, such as complex strictures and Sphincter of Oddi dysfunction, is equally challenging and requires close working between hepaticopancreaticobiliary (HPB) physicians, radiologists, surgeons and hepatologists.

A career in pancreaticobiliary medicine may appeal to doctors in training. There are rapidly developing diagnostic and therapeutic procedures for patients with pancreatic disease, emerging new clinical problems in the acute and long-term settings, together with a need for a personalised management approach. More physicians with such an interest will be required as the incidence of many pancreaticobiliary disorders is expected to rise as their aetiology is related to obesity and higher alcohol consumption. This paper discusses the potential development and components of a training programme in medical pancreatology, and the authors would welcome feedback on its suggestions.