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Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that requires abundant clinical experience and endoscopic skills, and can lead to various complications, some of which may progress to life-threatening conditions. With expanding indications and technological advancements, ERCP is widely utilized, enhancing procedural accessibility. However, without proper quality management, the procedure can pose significant risks. Quality management in ERCP is essential to ensure safe and successful procedures and meet societal demands for improved healthcare competitiveness. To address these concerns, the Korean Pancreatobiliary Association has developed a Korean-specific ERCP quality indicator reflecting domestic medical environments and realities. Initially, based on a review of foreign ERCP quality indicators and related literatures, key questions were formulated for five preprocedural items, three intra-procedural items, and four post-procedural items. Descriptions and recommendations for each item were selected through peer evaluation. The developed Korean-specific ERCP quality indicator was reviewed by external experts based on the latest evidence and consensus in this fields. This Korean-specific indicator is expected to significantly contribute to improving ERCP quality in Korea, as it is tailored to local needs. [ABSTRACT FROM AUTHOR]

Endoscopic sphincterotomy (EST) is a basic procedure for pancreatobiliary endoscopy and is currently widely performed as a standard procedure for the treatment of various pancreatobiliary diseases worldwide. Later, in 1982, endoscopic papillary balloon dilation (EPBD) was introduced as an alternative to EST, and EPBD is known to reduce the risk of bleeding and perforation compared to EST. In order to safely and effectively perform EST and EPBD procedures, it is essential to select an appropriate target for the procedure, as well as to understand and familiarize with the anatomical structure of the duodenal papilla, related instruments, and basic techniques of EST and EPBD. [ABSTRACT FROM AUTHOR]

To date, there is no standardization of the endoscopic retrograde cholangiopancreatography (ERCP) room setting regarding with the size, equipment or space arrangement. Therefore, the authors visited 11 tertiary hospitals that recently remodeled or newly designed the ERCP room to analyze and identify their advantages and disadvantages. The ERCP room should have enough space for equipments including fluoroscopy, endoscopy, electrosurgical unit, preparation table and for patient movement. The EUS room does not require an independent space unless it is a very large scale hospital, and the ERCP room can be shared. Considering the pros and cons of each equipment, adequate fluoroscopic device should be selected depending on the hospital circumstance. Expensive equipment for X-ray fluoroscopy system is not necessarily good, and it is necessary to install equipment suitable for each hospital situation by understanding the advantages and disadvantages of fluoroscopy. For prevention of ERCP-related radiation hazard, both endoscopist and assistants should wear radiation-blocking apron, thyroid protectors, and lead glasses. Furthermore, a shield that can block radiation between the endoscopist and the patient should be installed to protect high-energy scattered waves. One-way direction should be designed to prevent cross infection when moving the endoscopic equipment from the ERCP to the cleaning room. If possible, it is recommended to keep a cardiopulmonary resuscitation cart in the ERCP room. [ABSTRACT FROM AUTHOR]

Complications that may occur after an endoscopic retrograde cholangiopancreatography (ERCP) procedure include pancreatitis, bleeding, cholangitis, cholecystis, perforation, and post-ERCP pancreatitis (PEP). Of these, PEP is the most common complication and 10% of patients can die from severe pancreatitis. Prevention of PEP requires the selection of an appropriate patient group according to their ERCP indications and a full awareness of the risk factors. The incidence rate can be reduced to some extent through medication and ERCP manipulation changes. The use of a spile through the guidewire during ERCP manipulation and temporary pancreatic duct stent insertion can be effective, and the administration of suppository NSAIDs as medication reduces the occurrence of PEP. Drugs such as glyceryl trinitrate (GTN), nafamostat, and somatostatin can be considered as the second best treatment in the cases where NSAIDs are contraindicated or where a plastic catheter cannot be inserted or fails after insertion into the pancreatic duct. [ABSTRACT FROM AUTHOR]