The volume of ERCPs per endoscopist is associated with a higher technical success and a lower post-ERCP pancreatitis rates. A prospective analysis

conflicting results have been reported regarding the influence of the annual volume of ERCP on outcomes.to evaluate the influence of case volume on ERCP outcomes.analysis of a prospective database comparing the outcomes of ERCP in 3 consecutive periods defined by the number of endoscopists performing ERCP: 5 endoscopists in period I (P1), 4 in period II (P2) and 3 in period III (P3). Only patients with biliary ERCP in accessible and naïve papilla were included. Primary variables were cannulation rates and adverse effects (AE). ASGE complexity grades III and IV were considered highly complex procedures.We included 2561 patients: 727 (P1), 972 (P2) and 862 (P3). There were no differences in age and sex between groups (p0.05). The cannulation rate was significantly higher in P2 and P3: 92.4% vs. 93.3% vs. 93% (p=0.037). The AE rate was 13.8%, 12.6% and 10.3% (p0.05), respectively. The rate of post-ERCP pancreatitis was significantly lower in P3: 8.5%, 7.3% and 5% (p=0.01). The rate of complex procedures was 12%, 14.8% and 27% (p0.0001), respectively. Two endoscopists participated in all periods and only one significantly improved his outcomes. Cannulation and post-ERCP pancreatitis rates remained significantly better in P3 after adjusting for sex, complexity, and endoscopist.A higher annual volume of ERCP per endoscopist was associated with a higher rate of cannulation and a lower rate of post-ERCP pancreatitis, despite the greater complexity of the procedures. These beneficial effects seem to differ between endoscopists.