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Background Training in advanced endoscopic techniques such as endoscopic retrograde cholangiopancreatography (ERCP) should be driven by key performance measures and standardized competence assessment in order to provide safe and high-quality interventions. We aimed to determine whether the involvement of trainees influences the outcome of the procedure and the incidence of ERCP-related adverse events. Methods This was an international, multicenter, prospective, observational study conducted at six high- and low-volume centers across Europe between October 2016 and October 2018, and included independent operators and their trainees. Standard report forms documenting indication, trainee involvement, technical outcome, and complications over a 30-day follow-up of consecutive ERCP procedures were included in the analysis. Technical success of the procedure and procedure-related adverse events were compared between procedures in the trainee group and the control group using bivariable and multivariable analysis. Results 21 trainees and 16 control endoscopists performed 1843 ERCPs during the study period. Trainee involvement in ERCP procedures did not decrease technical success (92.4 % vs. 93.7 %; P = 0.30) or increase the risk of adverse events (14.7 % vs. 14.6 %; P > 0.99). Conversely, there were significantly more moderate or severe adverse events in the control group compared with the trainee group (6.2 % vs. 3.4 %, P = 0.01). On multivariable analysis, only increased bilirubin levels, time to cannulation, and procedure difficulty level increased the risk of any procedure-related adverse event. Conclusion Trainee involvement in ERCP interventions within a proper teaching setting is safe and does not compromise the success of the procedure.

Aims The unprecedented situation caused by the COVID-19 pandemic has profoundly affected endoscopic practice inregard to access, volume, and workflow. We aimed to assess the potential changes in the technical outcomes of ERCPprocedures carried out in patients with confirmed SARS-CoV-2 infection. Methods We conducted an international, multicenter, retrospective, matched case-control study of ERCP procedures carriedout in patients with confirmed COVID-19. The main outcome was technical success of the procedure as assessed by theendoscopist, and the secondary outcome was the development of procedure-related adverse events. Each case wasmatched in a 1:4 ratio with controls extracted from each center's database in order to identify relevant changes in outcomemeasures compared to the pre-pandemic era. Results Eighteen procedures performed in 16 COVID-19 patients (14 men, 65 years (9-82)) between the 15th of Marchand the 1st of July 2020 and 67 matched controls were included in the final analysis. Technical success was achieved in14/18 procedures in COVID-19 cases, which was significantly lower as compared to the control group (14/18 vs. 64/67, p=0.034), with an endoscopic reintervention required in 9/18 cases. However, the rate of procedure-related adverse eventswas low in both groups (1/18 vs. 10/67, p=0.44). On multivariable analysis COVID-19 status remained the only risk factorfor technical failure of the procedure (OR of 19.9 (95 %CI 1.4-269)).

Aims An outbreak of coronavirus disease 19 (COVID-19) has altered the dynamic of endoscopic practices. Many guidelines, questionnaires have been published addressing service resumption during the pandemic. Curious about the situation indifferent endoscopic units across the globe, the study was designed to evaluate different aspects of practice resumptionworldwide and their adherence to guidelines. Methods An online questionnaire was created and distributed by national/regional representatives and societies. Redcapplatform was used as the interface;afterwards, Microsoft Excel 2016 and Prism 5 were utilized for data analysis. Results From a total of 307 responses from 47 countries/regions was collected, 290 valid answers were analyzed. Almosthalf (47 %) were in post-peak period by August, 2020. Many units were not designated to be COVID-oriented facility. About15.5 % of centers remained unrecovered, mainly in North and South America;those were recovered, training was still withheld significantly. Nevertheless, opened centers kept safety measurements strictly. Patient load was decreased by 37 %,but waiting list was increased 0-25 %. Among many surveillance methods, body temperature, PCR and chest CT were themost common. 74.8 % increased post-procedural disinfection time and 68.2 % increase in per-case inspection were noted.PPE usage was implemented highly and shortage of these posed as one of the resumption barriers. Post-procedural patientsurveillance was not reinforced. Conclusions The study represented real-time global endoscopic service's adaptation to COVID-19 pandemic. Previouslypublished barriers upon practice resumption remained. Despite Delphi consensus' emphasis on post-procedural surveillance, application was not widely reinforced, raising concerns in disease control.

Background and aims: Pancreas divisum (PD) is the most common congenital variant of the pancreatic ductal system and a potential cause of acute recurrent pancreatitis (ARP). Endoscopic therapy is a...

IMPACT OF TRAINEE INVOLVEMENT ON TECHNICAL OUTCOME OF ERCP PROCEDURES AND PATIENT SAFETY: RESULTS OF A PROSPECTIVE MULTICENTER TRIAL