Who performs Endoscopic Retrograde Cholangiopancreatography (ERCP), a gastroenterologist or a surgeon?

Who Performs ERCP: Gastroenterologists or Surgeons?

ERCP (Endoscopic Retrograde Cholangiopancreatography) is typically performed by either gastroenterologists or general surgeons who have specialized training in advanced endoscopic procedures. 1

Provider Training and Qualifications

• ERCP is one of the most advanced therapeutic procedures in gastrointestinal endoscopy, requiring specific knowledge-based training to achieve competence 2
• Gastroenterologists and general surgeons perform ERCP in interventional suites or operating rooms, typically under general anesthesia 1
• The first ERCP was actually performed by surgeons in 1968 at George Washington University 3
• Training requires significant case volume - studies suggest at least 180-200 procedures are needed before a physician can be considered competent in ERCP 4
• The American College of Radiology recognizes both gastroenterologists and general surgeons as qualified providers of ERCP 1

Current Practice Patterns

• While ERCP is most commonly performed by gastroenterologists in current practice, surgeons with training in advanced gastrointestinal endoscopy have demonstrated similar success rates and outcomes 3
• At many institutions, adult gastroenterologists perform ERCP for pediatric patients when pediatric gastroenterologists lack adequate training in the procedure 5
• Studies show that adult gastroenterologists can safely and effectively perform ERCP in pediatric populations with high success rates (98.6% cannulation success rate in one study) 5

Procedure Details and Considerations

• ERCP involves advancing an endoscope into the duodenum, cannulating the ampulla, and injecting contrast into the common bile duct while obtaining fluoroscopic images 1
• The procedure may include therapeutic interventions such as sphincterotomy, biopsy, or stent deployment 1
• ERCP carries risks of major complications (4-5.2%) including pancreatitis, cholangitis, hemorrhage, and perforation, with a 0.4% mortality risk 1, 6
• The main indication for ERCP is management of common bile duct stones, which can be cleared via balloon sweep in 80-95% of cases 1, 6

Quality and Training Standards

• The British Society of Gastroenterology has issued a national standards framework for ERCP to ensure high-quality training and maintenance of skills 1
• Propofol-assisted ERCP is becoming more common, especially for complex cases, and may improve success rates and patient satisfaction 1
• For complex procedures like cholangioscopy-assisted lithotripsy, enhanced sedation or general anesthesia should be specifically considered 1

Common Clinical Applications

• ERCP is primarily used for therapeutic rather than diagnostic purposes due to advances in less invasive imaging techniques like MRCP 1
• Common indications include management of common bile duct stones, treatment of biliary leaks after laparoscopic cholecystectomy, and placement of stents for malignant biliary obstruction 1, 6
• ERCP is recommended for patients with gallstone pancreatitis who have concomitant cholangitis (within 24 hours) or high suspicion of persistent common bile duct stone (within 72 hours) 1

In summary, both gastroenterologists and general surgeons perform ERCP, with the key factor being specialized training in advanced endoscopic procedures rather than the provider's primary specialty.