Summary of the Statements, Grades of Recommendation, and Levels of Evidence
| Key question | Statement | Level of evidence | Grade of recommendation |
|---|---|---|---|
| 1 | We recommend that ERCP operators should obtain a certificate in pancreaticobiliary endoscopy from the KPBA. | IV | B |
| 2 | We recommend minimizing the frequency of ERCP procedures to appropriate indications for at least 80% of all procedures. If the procedure is not indicated, clear documentation of the reasons for performing it should be included in the report. | II | B |
| 3 | We recommend that healthcare providers obtain written informed consent from patients, or if necessary, from their legal representative, before performing ERCP. The informed consent should include the following information: the tentative diagnosis, necessity of the procedure, method and details of the procedure, alternatives to the procedure, name of the medical staff explaining the procedure, names of medical staff participating in the procedure, and expected adverse events. | III | A |
| 4 | We suggest assessing the procedural difficulty prior to the ERCP procedure because the success rate and incidence of complications may vary depending on the level of difficulty. | II | C |
| 5 | We recommend avoiding the routine use of prophylactic antibiotics before ERCP procedures. However, selective use of prophylactic antibiotics should be considered in patients who may have a high risk of developing cholangitis after ERCP. |
I II |
A C |
| 6 | We recommend a selective bile duct cannulation success rate of at least 90% in patients with a normal anatomy and naïve papilla. | II | A |
| 7 | We recommend a common bile duct stone extraction success rate of at least 90% in patients with a normal anatomy and stones smaller than 10 mm in size. | II | A |
| 8 | We recommend achieving a success rate of at least 90% for biliary stenting below the hepatic hilum using plastic or metallic stents, particularly when preceded by selective bile duct cannulation, in cases where incomplete drainage is expected, such as those with biliary strictures or incomplete common bile duct stone removal. | II | A |
| 9 | We recommend standardized reporting of ERCP procedures, including indications, findings, procedure details, and procedure-related complications, to enhance the quality of ERCP. | IV | A |
| 10 | We recommend maintaining the incidence of PEP below 10% in patients without risk factors for PEP. | II | B |
| 11 | We recommend maintaining a rate of clinically significant bleeding to less than 1% in patients undergoing endoscopic sphincterotomy with a low risk of bleeding. | II | B |
| 12 | We recommend that the incidence of perforation should be maintained below 0.5% when performing ERCP in patients with a normal anatomy and no risk factors for perforation. | II | B |
ERCP, endoscopic retrograde cholangiopancreatography; KPBA, Korean Pancreatobiliary Association; CBD, common bile duct; PEP, post-ERCP pancreatitis.