Editor,—We read with great interest the leading article by Hellier and Morris ((2000) Gut 47:459–60; ) regarding the future of endoscopic retrograde cholangiopancreatography (ERCP) training in the UK. They discuss the importance of restricting training in ERCP to some trainees and training only in centres that are accredited for training by the Joint Advisory Group (JAG) in Endoscopy. JAG, at the request of the Conference of Royal Colleges, produced endoscopy training guidelines.1 For ERCP training, these state that a centre should be performing a minimum of 250 procedures per annum (with specialist centres performing 500 per annum). They should also have regular meetings to discuss radiological findings with a radiologist with special interest in ERCP.

While we certainly agree with the importance of ensuring satisfactory training, we are concerned that the guidelines base competence for training in ERCP solely on the number of procedures carried out in individual centres. We have noted that larger centres often have several practitioners performing ERCP and several trainees learning. To determine the likely impact of the JAG recommendations on ERCP training and whether trainees were likely to have greater individual exposure to procedures in larger units, we performed a questionnaire based study, which was mailed to all acute UK hospitals. A total …