Endoscopic retrograde cholangiopancreatography quality, credentialing, and facility standards: a systematic review of societal guidelines and recommendations

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is a ubiquitous and high-risk procedure with variable performance across providers and centres. In this review, we aimed to summarize the evidence related to ERCP practice in 4 domains: indications and alternatives, quality indicators, training and credentialing, and facility standards. Methods We searched MEDLINE, Embase, Cochrane databases, and the grey literature (2000-2026) for ERCP quality standards published by professional societies or health agencies. Records were included if they included recommendations related to the 4 above-mentioned domains. Recommendations were described qualitatively. For quality indicators, we described benchmarks for performance, strength of recommendations, and quality of evidence when available. Results Fifty-seven reports were included from 4 continents. Eighteen unique indications were identified. Seventeen procedural quality indicators were identified. Priority indicators included appropriate indication (benchmark >90% of cases), cannulation success rate (≥85%-90%), management of common bile duct stones <1 cm (≥75%-90%) stent placement below the bifurcation (≥80%-95%), post-ERCP pancreatitis rate (≤6%-10%), and unplanned hospital visit within 30 days of ERCP (<15%). Training recommendations suggested minimum volumes of 100-300 supervised procedures and highlighted a shift towards competency-based assessment tools like The EUS and ERCP Skills Assessment Tool or Direct Observation of Procedural Skills. Facility standards focused on radiation safety, duodenoscope reprocessing/infection control, and mandatory photodocumentation. Conclusion There was substantial alignment among societies on several core ERCP quality metrics, yet variability remains in training and credentialing and facility standards. Significant gaps exist regarding maintenance of competence and ERCP assistant training. This evidence can support health authorities seeking to develop and implement ERCP quality improvement initiatives.