Reply to Arvanitakis et al.

Deep biliary cannulation, the cornerstone of ERCP, presents mentors with a conundrum: trainees require a longer time on the papilla to acquire cannulation skills [1], but prolonged cannulation attempts can compromise the procedure and increase the risk for the patient [2], even when experts eventually take over. Trainees were allowed more time, even in failed attempts, as their training progressed, which could reflect mentors trusting their trainees with more responsibilities as they advance in their training. One solution could be a two-tier training system, with novices focusing on acquiring the basic cannulation skills and more advanced training (grade 2 and 3 procedures) being reserved for endoscopists who are already deemed competent in basic cannulation. [Extracted from the article]