[The impact of minimum case numbers on the acquisition and maintenance of proficiency in advanced endoscopic...

Significant advances have been made in gastroenterological endoscopy, making it the treatment of choice in many cases. While several DGVS guidelines and publications provide standards for the quality of endoscopy, minimum case numbers for acquiring and maintaining proficiency have so far been addressed only partially. We have therefore developed recommendations for minimum case numbers for advanced endoscopic procedures and for TIPS implantation. Where possible, these recommendations are based on available evidence; otherwise, they are based on the authors' experience. Prerequisites include proficiency in diagnostic gastroscopy and colonoscopy - including simple procedures - as well as structured training under the guidance of experienced instructors. Ex vivo models may also be included. For competency acquisition, we recommend 70 endoscopic mucosal resections of polyps >2 cm (weak evidence), 60 endoscopic submucosal dissections (moderate evidence), 15 full-thickness resections (no evidence), 200 ERCPs (good evidence), 225 endosonographies (weak evidence), 50 endoscopic hemostases (weak evidence), and 25 POEMs (for endoscopists experienced in ESD). For TIPS placements, we recommend 20 per year per center (good evidence). We see no basis for a separate recommendation regarding stenting and occlusion techniques. Widespread implementation of these guidelines can lead to an improvement in the quality of care and is a prerequisite for the establishment of endoscopic centers.