Commentary on: gutjnl-2025-335548.R2—endoscopic retrograde cholangiopancreatography (ERCP) services across the UK

Endoscopic retrograde cholangiopancreatography (ERCP) remains the most challenging of all commonly performed endoscopic procedures and (along with allied techniques including interventional endoscopic ultrasound (EUS) and cholangioscopy) is increasingly used to resolve problems previously the domain of interventional radiology or surgery. In 2014, the British Society of Gastroenterology (BSG) set out a number of minimum and aspirational standards, largely centred on individual ERCPist and endoscopy unit key performance indicators (KPIs).1 The present study is a national survey of ERCP practice, aimed at assessing the delivery of care according to these KPIs and other criteria, viewed as appropriate surrogate markers of good practice.2 The investigators are to be commended for receiving feedback from 100% of the 170 units delivering ERCP in the UK. The results may be considered in terms of overall ERCP service and the individuals performing the procedures. With regard to units delivering ERCP, there are significant variations in ‘the numbers game’, with 22% of units reporting ERCP activity below the minimum KPI of 150/year, and 34% performing less than the aspirational goal of >200/year. The authors apply a novel scoring system to combine indicators of good practice. This aims to give an indication of the overall quality of a service. The composite domain scores are instructive, in that features of a service characterised (justifiably) as predicting high quality (ie, >200 ERCPs/year, multidisciplinary team meeting (MDM) provision and reliable availability of both EUS and anaesthetic support) are …