How to measure quality in ERCP?

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a technically complex and high-risk procedure for managing pancreaticobiliary diseases. The quality assessment in ERCP has evolved from relying solely on adverse events (AEs) rates to a more comprehensive approach incorporating structural, process, and outcome indicators. Structural metrics include appropriate indications, informed consent, and procedural difficulty grading. Process metrics focus on bile duct cannulation, stone clearance, stent placement, and radiation exposure documentation. Outcome metrics assess AEs, such as post-ERCP pancreatitis and bleeding rates. Patient-reported outcome measures are valuable tools for capturing morbidity beyond traditional quality metrics. Competency in ERCP requires structured training, continuous assessment, and mentored practice. High-volume centres consistently demonstrate superior outcomes, reinforcing the need for centralisation and robust quality assurance programs. Future advancements, including artificial intelligence and large-scale registries, promise to standardise practices and improve ERCP outcomes. This review provides a comprehensive framework to measure and enhance quality in ERCP.