An evaluation of performance after informal training in endoscopic retrograde sphincterotomy

Endoscopic retrograde sphincterotomy (ERS) has become the treatment of choice for certain disorders of the biliary tract and pancreas. Increased need for ERS has led experienced endoscopists to seek advanced training in this highly skilled procedure, and has resulted in the development of guidelines from the American Society for Gastrointestinal Endoscopy regarding appropriate experience, skill, and training before performing ERS. This report describes the process by which an endoscopist skilled in endoscopic retrograde cholangiopancreatography, but with no prior training in ERS, acquired appropriate training. Results in the initial 75 patients attempted after training are reported and compared with previously published data. The results suggest that skill comparable to published results was attained through adherence to the American Society for Gastrointestinal Endoscopy guidelines, and that most technical failures and complications occurred early in the series. The results also reinforce the increasing role of ERS in several disorders of the biliary tract and pancreas.