105 3323 Endoscopic Retrograde Cholangiopancreatography (ERCP) Performed by UGI Surgeons: Is It “beyond the Scope”? Outcomes From 9 Years of a Unique Service and Looking to the Future of ERCP Amidst a National Workforce Crisis

Abstract Aim ERCP has evolved from a diagnostic modality, to almost entirely a therapeutic tool for surgical pathology. In the UK, ERCP is delivered primarily by gastroenterologists with only 11% by surgeons (BSG 2024); and 37% of the total workforce will retire in the next 5 years. Our unit has an exclusively surgery-led practice, with an in-house training programme. We aimed to evaluate our structured set up and draw lessons for a national initiative. Method The programme was started in 1992 by a surgical visionary and through succession planning, the service is now provided by 3 UGI surgeons. Earlier initiates mentored the next generation of carefully selected surgeons, with focus on professional development and excellence. We hereby analyse a prospectively collected database with reference to the BSG’s key performance indicators (KPIs) and recommendations of JAG on training. Results From September 2016 to May 2025, we performed 3323 ERCP, average 383/ year. All the KPIs are met individually and by the group; annual individual average caseload – 132, cannulation for first ERCP 93.8% (BSG>85%), stone clearance - 78.1% (BSG>75%), extrahepatic stricture stented - 82.1% (BSG>80%), complication rate - 5.8% (BSG <6%). Mentees achieved competence (200 cases v BSG 300) and key targets ahead of the stipulations by JAG. Conclusions UGI surgeons have a natural aptitude for ERCP, given the sound knowledge of anatomy and spatial awareness. ERCP is an enhanced tool, which should be tailored for surgeons; an approach that will help and change the national outlook and promote sustainability.