TY - JOUR T1 - Controversies in ERCP: frontline Gastroenterology Twitter debate JF - Frontline Gastroenterology JO - Frontline Gastroenterol SP - 158 LP - 161 DO - 10.1136/flgastro-2020-101479 VL - 12 IS - 2 AU - Muhammad Ishtiaq AU - Fahd Rana AU - James Maurice AU - Matthew T Huggett AU - Simon M Everett Y1 - 2021/03/01 UR - http://fg.bmj.com/content/12/2/158.abstract N2 - Take home messagesOrganisations 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.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 deliveryIs 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 … ER -