How to measure quality in endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic technique that was developed in the 1960’s to diagnose pancreatobiliary pathology. Since it has evolved from a purely diagnostic to predominately therapeutic procedure. It established as one of the most demanding and technically challenging procedures in gastrointestinal endoscopy, requiring a specific training and learning curve to master. In the recent years, multiple guidelines on measuring quality in ERCP have been published. The internet era had made it widely available for patients to research and ask about the level of success of their operator in performing the procedure and complication rates. Until recently complication rate was the only measure to evaluate outcome, because ERCP is associated with greater morbidity and mortality when compared to other endoscopic procedures such as colonoscopy and gastroscopy. It shortly became obvious that additional measures must be established to evaluate quality in ERCP. Hereby, we attempt to identify the standardized methods to measure quality, after a comprehensive review of the literature.