Integrating ERCP Within UK Higher Surgical Training: A Structured, Curriculum-Embedded Model

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is integral to hepatopancreatobiliary (HPB) surgical practice, yet structured access to ERCP training within UK higher surgical training (HST) remains limited. Barriers include rota commitments, competing operative priorities, and restricted access to endoscopy lists. This study describes a structured, curriculum-integrated ERCP training model and examines the systemic factors influencing surgical trainee exposure. Methods: A structured ERCP training model embedded within UK HST is described and evaluated using a longitudinal case-study exemplar using prospectively logged data. Procedural volume, key performance indicators (KPIs), and levels of supervision were analyzed using data from the Joint Advisory Group (JAG) Endoscopy Training System (JETS) e-portfolio. Variation in annual case exposure was examined in relation to rota commitments, endoscopy list availability, and center-specific training infrastructure. Results: Over a 33-month period, 365 ERCP procedures were completed, consistent with and exceeding the JAG-reported median of ∼300 supervised procedures required for certification. Procedural exposure varied across training rotations, reflecting differences in service configuration and access to ERCP lists. KPIs improved progressively in keeping with recognized ERCP learning curves, with native papilla cannulation rates exceeding 90% early within the structured training pathway, following an initial learning phase and sustained achievement of therapeutic benchmarks for stone clearance and biliary stenting. Conclusion: This study demonstrates that ERCP competence can be achieved within UK higher surgical training when exposure is intentionally integrated into HPB rotations and supported by structured planning, longitudinal mentorship, and access to high-volume endoscopy services. The training model highlights transferable strategies to overcome systemic barriers to surgical ERCP training and may inform future curriculum development to support sustainable ERCP service provision.