BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) still has a relatively high complication rate, underscoring the importance of high-quality training. Despite existing guidelines, real-world data on training conditions remain limited. This pan-European survey aims to systematically explore the perceptions surrounding ERCP training. METHODS: A survey was distributed through the friends of United European Gastroenterology (UEG) Young Talent Group network to physicians working in a UEG member or associated states who regularly performed ERCPs. RESULTS: Of 1035 respondents from 35 countries, 649 were eligible for analysis: 228 trainees, 225 trainers, and 196 individuals who regularly performed ERCP but were neither trainees nor trainers. The mean age was 43 years, with 72.1% identifying as male, 27.6% as female, and 0.3% as non-binary. The majority (80.1%) agreed that a structured training regimen is desirable. However, only 13.7% of trainees and 28.4% of trainers reported having such a structured program in their institutions. Most respondents (79.7%) supported the concept of concentrating training in centers meeting specific quality metrics, with 64.1% suggesting a threshold of 200 annual ERCPs as a prerequisite. This threshold revealed that 36.4% of trainees pursued training in lower-volume centers performing <200 ERCPs annually. As many as 70.1% of trainees performed <50 annual ERCPs, whereas only 5.0% of trainers performed <50 ERCPs annually. A low individual trainee caseload (<50 ERCPs annually) was more common in lower-volume centers than in higher-volume centers (82.9% vs. 63.4%). CONCLUSIONS: The first pan-European survey investigating ERCP training conditions reveals strong support for structured training and the concentration of training efforts within centers meeting specific quality metrics. Furthermore, this survey exposes the low availability of structured training programs with many trainees practicing at lower-volume centers and 71% of all trainees having little hands-on exposure. These data should motivate to standardize ERCP training conditions further and ultimately improve patient care throughout Europe.

2nd Department of Internal Medicine Gastroenterology and Geriatrics University Hospital Olomouc Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czech Republic

Berlin Institute of Health at Charité Berlin Germany

Carol Davila University of Medicine and Pharmacy Bucharest Romania

Clinic of Internal Medicine Gastroenterology JFM CU Jessenius Faculty of Medicine in Martin Comenius University in Bratislava Martin Slovakia

Colorectal Surgery Vall d'Hebron University Hospital Universitat Autonoma de Barcelona UAB Barcelona Spain

Department of Advanced Medical and Surgical Sciences Università degli Studi della Campania Luigi Vanvitelli Naples Italy

Department of Biochemistry Medical University of Lodz Lodz Poland

Department of Gastroenterology and Digestive Endoscopy Masaryk Memorial Cancer Institute Brno Czech Republic

Department of Gastroenterology and Hepatology Clarunis Universitäres Bauchzentrum Universitätsspital Basel Basel Switzerland

Department of Gastroenterology and Hepatology Erasmus MC University Medical Center Rotterdam The Netherlands

Department of Gastroenterology and Hepatology Hacettepe University Faculty of Medicine Ankara Turkey

Department of Gastroenterology and Hepatology National Liver Institute Menoufia University Al Minufiyah Egypt

Department of Gastroenterology and Hepatology University Clinical Center Tuzla Tuzla Bosnia and Herzegovina

Department of Gastroenterology and Hepatology University Hospital Centre Zagreb Zagreb Croatia

Department of Gastroenterology and Hepatology University Hospitals Leuven Leuven Belgium

Department of Gastroenterology Azerbaijan Medical University Baku Azerbaijan

Department of Gastroenterology Colentina Clinical Hospital Bucharest Romania

Department of Gastroenterology Diagnostic Center Rogaska Rogaška Slatina Slovenia

Department of Gastroenterology East Tallinn Central Hospital Tallinn Estonia

Department of Gastroenterology Endocrinology Infectious Diseases University of Marburg UKGM Marburg Germany

Department of Gastroenterology Liverpool University Hospitals Foundation Trust Liverpool UK

Department of Gastroenterology NIMTS Hospital Athens Greece

Department of Gastroenterology Rheumatology and Infectiology Charité Universitätsmedizin Berlin Berlin Germany

Department of Gastroenterology St Josef Hospital A Hospital of the Ruhr University Bochum Bochum Germany

Department of Gastroenterology St Vincent's University Hospital Dublin Ireland

Department of Internal Medicine 1 University Hospital Regensburg Regensburg Germany

Department of Internal Medicine 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Internal Medicine University Hospital Sveta Marina Pleven Medical University Pleven Pleven Bulgaria

Department of Medicine 4 Heidelberg University Hospital Heidelberg Germany

Department of Surgery University Hospital Brno Faculty of Medicine Masaryk University Brno Czech Republic

Department of the Study of Digestive System Diseases and their Comorbidity with Non communicable Diseases L T Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine Kharkiv Ukraine

Department of Visceral Thoracic and Vascular Surgery Medical Faculty University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany

Division of Gastroenterology and Hepatology Department of Internal Medicine 3 Medical University of Vienna Vienna Austria

Division of Gastroenterology and Hepatology Department of Internal Medicine University Hospital Center Mother Theresa Tirana Albania

Division of Gastroenterology Department of Medicine Mater Dei Hospital Msida Malta

Division of Medicine Institute for Liver and Digestive Health Royal Free Hospital University College London London UK

Faculty of Medicine and Pharmacy University Hospital Mohamed 6 of Tangier Tangier Morocco

Gastroenterology and Hepatology Department Clinical and Translational Research in Digestive Diseases Valdecilla Research Institute Marqués de Valdecilla University Hospital Santander Spain

Gastroenterology and Hepatology Department Internal Security Forces Hospital La Marsa Tunis Tunisia

Gastroenterology and Multivisceral Transplant Unit Padova University Hospital Padova Italy

Gastroenterology Clinic University Clinical Center of Kosova Prishtine Kosova

Gastroenterology Clinic University Hospitals Coventry and Warwickshire Coventry UK

Gastroenterology Department Hospital São Teotónio ULS Viseu Dão Lafões Viseu Portugal

Gastroenterology Hepatology and Nutrition Clinic Riga East Clinical University Hospital Riga Latvia

Hepatogastroenterology Department Institute for Clinical and Experimental Medicine Prague Czech Republic

Hospital Riga Stradins University Riga Latvia

Institute of Systems Molecular and Integrative Biology Liverpool University Liverpool UK

Interdisciplinary Endoscopy University Hospital RWTH Aachen Aachen Germany

Junge Gastroenterologie German Young Gastroenterology Study Group of the DGVS German Society for Digestive and Metabolic Diseases Berlin Germany

Medical Clinic 3 Gastroenterology Metabolic Diseases and Intensive Care University Hospital RWTH Aachen Aachen Germany

Pancreatitis Centre East Gastrounit Copenhagen University Hospital Hvidovre Copenhagen Denmark

University Clinical Center of Serbia Belgrade Serbia

Vilnius University Hospital Santara Clinics Vilnius Lithuania

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