At least 180 ERCPs are needed to attain competence in diagnostic and therapeutic ERCP

Aim: To evaluate the number of ERCPs gastroenterology fellows should perform to achieve competency. Methods: From July 1993 to June 1995 consecutive ERCPs performed by fellows were graded on a standardized evaluation form. Success in specific technical components of ERCP was graded as successful, failed, or not attempted. Competence in these technical components was defined a priori as success at least 80% of the time. A separate overall score (1-6) was also given (1-3 if the fellow was thought to be competent and 4-6 if not yet competent). Overall competence required a score of 1,2, or 3 in 100% of ERCPs. Results: Forms were completed for 1,450/1,796 (81%) ERCPs. The table gives the percent of procedures (95% confidence interval), in groups of 20, in which the fellows were graded as successful for the technical components listed. Number of Procedures 41-60 81-100 121-140 161-180 Pancreatogram 71 (62-79) 78 (71-86) 75 (66-83) 85 (76-94) Common bile duct 53 (44-61) 68 (60-75) 69 (61-77) 73 (62-83) Deep pancreas 68 (49-88) 64 (47-82) 62 (46-78) 67 (47-87) Deep bile duct 56 (46-66) 67 (59-76) 72 (63-81) 65 (53-78) Stent insertion 81 (69-93) 78 (65-92) 86 (75-96) 95 (85-100) Stone extraction 38 (17-59) 59 (39-80) 54 (27-81) 80 (45-100) Sphincterotomy 47 (25-70) 50 (28-72) 46 (19-73) 60 (17-100) Fellows were given an overall score consistent with competency (1,2, or 3) 92.4% of the time when they had performed between 161 and 180 ERCPs (n=79), and 100% of the time when they had performed between 181 and 200 ERCPs (n=7). Conclusion: These preliminary data suggest that our gastroenterology fellows require more than 180 ERCPs to achieve competence in all technical components (upper limit of 95% confidence interval is still <80% for deep bile duct after 180 ERCPs), and between 180 and 200 ERCPs before achieving a competent overall score. These numbers are significantly more than the threshold numbers recommended by the ASGE. The data will be useful for assessing the resources necessary to train fellows in ERCP.

Duke Scholars

Author Malcolm Stanley Branch Medicine, Gastroenterology

Author Paul Simon Jowell Medicine, Gastroenterology