Highlights of Updated Multi-Society ERCP Guidelines

ERCP is a technically complex and high-risk endoscopic procedure, making quality assurance essential. This multi-society joint publication by the American Society for Gastrointestinal Endoscopy and American College of Gastroenterology represents the third iteration of quality indicators for ERCP, updating the previous 2015 standards. The Task Force re-evaluated existing metrics and introduced new priority indicators based on accumulated evidence since the prior publication.

Key updates and priority indicators include:

• Universal rectal nonsteroidal anti-inflammatory drugs: The recommendation for rectal nonsteroidal anti-inflammatory drugs (NSAIDs; indomethacin or diclofenac) is a central feature of the document. It is a priority indicator that recommends use in all patients with an intact papilla (target >90%), not just high-risk cases.
• Stone extraction: The metric for successful extraction of extrahepatic stones (target >90%) now includes stones >10 mm, reflecting the expectation that high-quality ERCP entails proficiency with same-session advanced extraction techniques.
• Unplanned hospitalizations: A new priority outcome measure recommends tracking the frequency of unplanned hospitalizations within 30 days of ERCP (target <15%), serving as a comprehensive surrogate for postprocedural morbidity.
• Pancreatic stents: A new process measure outlines the approach to documenting placement of and tracking prophylactic pancreatic stent placement (PSP) in high-risk cases (target >98%), reinforcing its continued importance in the era of rectal NSAIDs.
• Deep cannulation: The target for deep cannulation of the duct of interest remains >90%. The authors note the complexity around the intersection of endoscopic ultrasound (EUS)-guided biliary drainage and ERCP; however, for this metric, the definition of “ERCP failure” explicitly includes cases salvaged by EUS-guided biliary drainage.