The study by Williams et al, ¹ published in this issue of Gut(see page 796), reports the findings of a UK National Confidential Enquiry into Patient Outcomes and Deaths relating to endoscopic retrograde cholangiopancreatography (ERCP). Approximately 48 000 ERCPs are performed annually in the UK. For this study, five metropolitan areas of England were surveyed. The authors estimate that about 20% of all the ERCP procedures performed in adults (>18 years of age) over a 6-month period were captured. The results offer a cornucopia of food for thought. In all, 94% (76/81) of endoscopy units polled responded. Personal questionnaires were returned by 89% of staff endoscopists and by 81% of their trainees. Aspects of ERCP that were examined ranged from the experience and success of the physicians performing the procedures, to indications, informed consent, adequacy of monitoring and resuscitation, and outcomes, including complications and mortality. More than a few of the findings are sobering, concerning and demand remedial action. But we acknowledge that it is easy to be an armchair critic of another country’s ERCP practice. An in-depth look at ERCP practice in the US and Italy, for example, would probably reveal some, if not many, of the same problems arising from marginal training, inexperience, inadequate volume of cases to maintain skills and so on.

The current study looked at the success rates of trainees as a function of their experience. Those with experience of >200 ERCPs had an unsupervised cannulation rate (to enter the duct of choice) of 66%; this fell to 40% for those with experience of <200 ERCPs. The overall trainee cannulation success rate with procedures whose trainee involvement was not documented, was reportedly 54%. The American Society for Gastrointestinal Endoscopy (ASGE) considers a selective cannulation success …