LAUSR

Despite repeated studies, editorials, and gastroenterology society papers, credentialing committees have yet to take the initiative and require increased scrutiny for both hospital and procedural outcomes. Regarding credentialing for ERCP, stagnant is truly an understatement. The development of quality indicators and means of assessing competence in ERCP have been topics of conversation for over 10 years now. Despite multiple studies showing that higher volumes for both endoscopists and hospitals lead to better outcomes, this research has previously not changed how many hospitals credential, monitor, and grant privilege renewal for performing ERCP. Newly published competence guidelines from the American Society for Gastrointestinal Endoscopy (ASGE) recommend that competence-based credentialing decisions for ERCP should be based on several achievements, including performance of more than 200 supervised but independently performed procedures with greater than 90% selective cannulation, and performance of at least 80 independent sphincterotomies. Priority quality measures to assess ongoing competence include procedural volume, with appropriate indications, frequency of deep cannulation for native papillae, rate of removal of stones less than 1 cm in normal anatomy, successful biliary stent placement in distal bile duct obstruction, and rate of post-ERCP pancreatitis. The use of national monitoring databases, currently tracking EGD and colonoscopy indicators, has been advocated by multiple societies. Extension to ERCP has been discussed but not yet implemented in a meaningful and easily accessible way. Despite the increased emphasis on quality and competence from professional gastroenterology societies, hospital credentialing committees seem to have not followed suit. In the current issue of Gastrointestinal Endoscopy, the study by Cotton et al highlights this issue in an alarming way. This study used a 19-question survey sent to practicing gastroenterologists to assess credentialing patterns for ERCP in the United States. One fifth of the survey respondents reported no written guidelines from their hospital for initial credentialing for ERCP. Additionally, the recommended standards for volume have not been implemented into most hospital credentialing applications, and additional quality indicators that have been shown to correlate with outcomes, including number of sphincterotomies performed and rates of achievement of deep biliary cannulation, also