Stricter national standards are required for credentialing of endoscopic-retrograde-cholangiopancreatography in the United States

Table 3 Ongoing controversies in endoscopic-retrograde-cholangiopancreatography training and privileging

Ongoing controversies in endoscopic-retrograde-cholangiopancreatography training and privileging
1 What minimum number (if any) of ERCPs should be performed during a dedicated advanced training fellowship to justify credentialing?
2 What minimum number of ERCPs should be documented by a physician who seeks credentialing in ERCP after completing a standard 3 yr GI fellowship?
3 What should the profile of submitted ERCPs consist of in terms of therapeutic interventions?
4 Should all new physicians granted ERCP privileges have a probation period with monitoring by a proctor, and if so for how long?
5 What criteria, other than numbers, should be used to assess competency in ERCP?
Cannulation of desired duct(s)
Procedure outcome
Patient outcome
Complication rate
Monitoring of ERCPs during a probation period.
6 Should administrators of standard gastroenterology fellowship training programs that are 3 yr long be allowed to certify GI fellows in ERCP or should credentialing be restricted only to GI fellows who have completed an extra year of advanced endoscopy training?
7 Is post-training proctoring acceptable as a means to attain ERCP competency?
8 Should EUS training be mandatory for ERCP performance?
9 Should advanced GI fellowship training programs offer only a dedicated EUS or ERCP pathway but not both?
10 Should curriculum content for advanced therapeutic training be nationally standardized? Are there a sufficient number of advanced GI endoscopy program fellowships and are they of sufficient duration?
11 Should manpower concerns affect ERCP credentialing or should standards for competency be the only consideration?
12 Should individual hospital needs for ERCP operators affect credentialing?
13 Should all ERCP practitioners be compelled to participate in an on-call rotation for emergency ERCPs to be performed at night or on weekends?
14 Should all GI endoscopists with staff privileges for ERCP be compelled to join a rotation to perform ERCPs on public uninsured patients?
15 Should all ERCP practitioners be required to perform a minimum number of ERCPs per annum to maintain ERCP privileges (proficiency)? If so, what is the minimum number: 25 or 50 ERCPs per annum?
16 Should a national board exam, similar in concept to the examination in Gastroenterology by the American Board of Medicine be required for certification in ERCP to assess cognitive knowledge in ERCP and related clinical disciplines?

ERCP: Endoscopic retrograde cholangiopancreatography; GI: Gastrointestinal.