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Controversies in ERCP: frontline Gastroenterology Twitter debate
  1. Muhammad Ishtiaq1,
  2. Fahd Rana1,
  3. James Maurice2,
  4. Matthew T Huggett3,
  5. Simon M Everett4
  1. 1Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2Department of Gastroenterology, Barts Health NHS Trust, London, UK
  3. 3Gastroenterology, St James's University Hospital, The Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
  4. 4Gastroenterology, St James's University Hospital NHS Trust, Leeds, UK
  1. Correspondence to Dr Simon M Everett, Gastroenterology, St James's University Hospital NHS Trust, Leeds LS9 7TF, UK; simon.everett{at}nhs.net

https://doi.org/10.1136/flgastro-2020-101479

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    Take home messages

    • Organisations need to consider service delivery and regional networks to manage patients with acute cholangitis.

    • Trainees should aim to start training in endoscopic retrograde cholangiopancreatography (ERCP) early, in liaison with their training programme director (TPD) and consider applying for a postcompletion of training fellowship in ERCP to achieve competence before commencing consultant practice.

    • Endoscopic ultrasound is an emerging therapeutic technique, which goes hand in hand with ERCP, but it is not mandatory to cotrain in both procedures.

    • Early biliary drainage in acute cholangitis reduces mortality.

    Introduction

    This article continues our ‘Controversies in’ series for the Frontline Gastroenterology Twitter debates. The focus of the debate was endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS), in which training, service configuration and management of challenging cases were discussed. We aim to summarise the key points from the debate.

    Training and service delivery

    Is the current UK training system appropriately set up for training in ERCP?

    The discussion started with the current setup for ERCP training in the UK. ERCP, unlike oesophagogastroduodenoscopy (OGD) and colonoscopy, is optional for training in gastroenterology. Currently in the UK, gastroenterology training is combined with general internal medicine (GIM) and there are mandatory competencies in subspecialties like inflammatory bowel disease (IBD), hepatology and nutrition. Trainees often find it challenging to achieve competency in therapeutic OGD and level 2 colonoscopy, and it is anticipated that the situation may become even more difficult with the new internal medicine training system, which would leave less time for endoscopy training.

    Consequently, trainees with an interest in ERCP are unable to achieve competency in this domain of endoscopy during the completion of training (CCT) and are left with no other choice but to pursue further training in the form of a post-CCT fellowship. This, combined with service standards1 that require minimum numbers of procedures per annum, has led to a reduction in the number of consultants undertaking ERCP. With fewer people …

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    Footnotes

    • Twitter @jamesbmaurice

    • Contributors MI, FR and JM wrote the manuscript. MTH and SME provided overall supervision and approved final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.