Canadian credentialing guidelines for endoscopic retrograde cholangiopancreatography.

1St Joseph’s Health Centre, Toronto, Ontario; 2Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia; 3Division of Gastroenterology and Hepatology, Departments of Medicine and Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, South Carolina, USA; 4Division of Gastroenterology, University of Western Ontario, London, Ontario; 5Division of Gastroenterology, McGill University, Montreal, Quebec; 6Division of Gastroenterology, McMaster University, Hamilton, Ontario Correspondence: Dr David Armstrong, Division of Gastroenterology, HSC-2F55, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z5. Telephone 905-521-2100 ext 76404, fax 905-523-6048, e-mail [email protected] Received and accepted for publication May 5, 2008 Aseries of credentialing guidelines for gastrointestinal endoscopic procedures performed in the management of adult patients has been developed by the Canadian Association of Gastroenterology (CAG) Endoscopy Committee. After review, the guidelines were approved by the Clinical Affairs Committee and endorsed by the Executive Board. In the present article, the CAG suggests specific guidelines for credentialing endoscopic retrograde cholangiopancreatography (ERCP). It is intended to be read in conjunction with the introductory article that outlines the principles of credentialing (1). The CAG does not credential individuals for endoscopic procedures; that is the responsibility of the endoscopist’s local institution or facility. The purpose of these guidelines is to provide a framework that will allow organizations to assess the training and competence of applicants to perform ERCP, as part of the credentialing process for the granting of privileges. ERCP is an advanced endoscopic procedure that is used for the management of many pancreaticobiliary conditions. It is one of the most technically demanding and highest-risk procedures performed by endoscopists. Therefore, it requires comprehensive training and experience to perform competently. The CAG credentialing criteria for ERCP apply to the investigation of adult patients, aged 18 years or older; the basic principles also apply to ERCP in pediatric patients but, because the number of procedures required to achieve and maintain competence may differ, guidance on credentialing for pediatric endoscopy is considered to be the responsibility of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. COGNITIVE ASPECTS The cognitive aspects of ERCP are important and include an understanding of the indications for and contraindications to the procedure, the appropriateness of different diagnostic and therapeutic modalities in the management of obstructing and nonobstructing pancreaticobiliary ductal lesions (benign or malignant), informed consent, sedation, and reporting and documentation. The practitioner should be able to interpret the findings, implement an appropriate management plan and manage any complications that might arise during and after the procedure. Understanding the risks and benefits of ERCP in certain patient groups, as well as alternative investigations (including their limitations and complications) such as computed tomography, magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) is paramount for adequate management of patients with hepatobiliary and pancreatic disorders (2-4). For difficult cases, this usually involves a multidisciplinary approach, in which both surgical and radiological expertise can be obtained.