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

Table 5 Determining competency for endoscopic-retrograde-cholangiopancreatography

Duties of GI fellow applying for ERCP privileges at a hospital	Duties of GI supervisor of ERCP training/GI fellowship program director	Duties of hospital committee voting on ERCP privileges for applying physician
Contemporaneously sign each ERCP note in which actively participated	Ascertain GI fellow signs ERCP notes when the fellow actively participated in case
Can contemporaneously sign each note in which merely observed ERCP, but observer status should be reflected in note	Allow fellow to sign on note as an observer (not active participant) in cases in which fellow was passive observer	Passive observation of an ERCP should be meaningful in enhancing cognitive skills for ERCP, but cannot count towards minimum threshold for performed ERCPs
ERCP note in which GI fellow participated should specify what technical procedures performed during ERCP: e.g., sphincterotomy, stone extraction, dilation of stenosis, and etc.	Ascertain that endoscopy report includes all technical aspects of the performed ERCP	Ascertain that received data is complete
Collate all numbers performed for ERCP: Number performed, number (%) cannulated, number with sphincterotomy, number with stone retrieval, number of strictures dilated, and etc.	Review total numbers of ERCPs and number of ERCPs in which special techniques were employed as appropriate. Record rate (%) of success of special techniques.	Review total numbers of ERCPs and number (%) of ERCP special procedures and determine whether these data satisfy minimal numbers and minimal % of successful result required for competency
Make sure packet with ERCP numbers and recommendations is submitted in a timely manner at hospital applicant is applying for ERCP privileges	Sign form containing total number of ERCPs, and write whether GI fellow is recommended for independent privileges in ERCP	Decide in a timely manner whether physician granted ERCP privileges. If decision is negative, provide internal due process to appeal decision

Duties of graduating gastrointestinal fellow, endoscopic-retrograde-cholangiopancreatography supervisors during fellowship training, and credentialing committee at hospital to which applicant is applying for endoscopic-retrograde-cholangiopancreatography privileges. ERCP: Endoscopic retrograde cholangiopancreatography; GI: Gastrointestinal.