Bret T. Petersen, MD, MASGE

Associate Editor



Bret T. Petersen, MD, MASGE, is Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. His practice is focused in the Mayo Pancreas Clinic and the Advanced Endoscopy Group. His professional interests include pancreatic and biliary diseases, performance and outcomes of ERCP, and delivery of endoscopic services. At Mayo, Dr. Petersen is a past Director of Endoscopy and has served on multiple clinic and foundation committees. He has directed numerous American Society for Gastrointestinal Endoscopy (ASGE) and Mayo courses, particularly related to the performance of ERCP. He has received the Mayo Award for Excellence, GI Fellows Award for Outstanding Teacher, and Department of Medicine Laureate Award (GI), as well as the Master Endoscopist Award of the ASGE. Dr. Petersen is the incoming Secretary for (ASGE) and a past Chair of the Technology and Quality Assurance in Endoscopy committees.



Boston Scientific 

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Ethicon/J & J



ASGE Complexity Scale for ERCP Correlates With Success and Complications

Bret T. Petersen, MD, MASGE reviewing Sahar N, et al. Surgical Endoscopy 2019 Feb.

    Grading scales that accurately anticipate the complexity and risk of endoscopic retrograde cholangiopancreatography (ERCP) would be valuable for appropriate decision-making, triage, and informed consent. This study sought to retrospectively validate the previously described scale for complexity of ERCP developed by the American Society for Gastrointestinal Endoscopy (ASGE) (Gastrointest Endosc 2011;73:868-874). Complexity grade, technical success, and complications were recorded for 1355 procedures on 934 patients over a 12-month period. Patients had a mean age of 58 years and were balanced by gender and complexity grades (Grade 1+2=29%, 3=51%, and 4=20%). 88% of Grade 4 patients had altered anatomy. Cannulation was more successful in grades 1-3 than 4 (98% vs 88%, p<0.05). Complications were similar among the groups, occurring in 10% overall, with rates for post-ERCP pancreatitis of 5.4% and bleeding of 1.5%. Perforations were more common among grade 4 cases (4 cases, 1.5%) than among grades 1-3 (3 cases, 0.3%, p=0.010).

Prospective validation and potential refinement of the intermediate grades of the ASGE criteria are the next steps. In the meantime, practitioners can readily employ the currently available scale to inform their decision-making about in whom, by whom, and when difficult procedures might best be performed.


Sahar N, La Selva D, Gluck M, et al. The ASGE grading system for ERCP can predict success and complication rates in a tertiary referral hospital. Surg Endosc 2019;33:448-453. (