Endoscopic Retrograde Cholangiopancreatography (ERCP) is a well-established therapeutic and diagnostic procedure for managing diseases of the bile ducts, ampulla of Vater complex, and pancreatic duct system. This includes stone extraction, stent placement for obstructions, stricture dilation, and biopsy of malignant-appearing changes.

ERCP has significant therapeutic value, but it is associated with notable complications such as post-ERCP pancreatitis, bleeding, infection/cholangitis, and perforation. Advances in stents, endoscopic equipment, hemostatic agents, and radiological interventions have improved the management of complications, making it increasingly a specialist task.

International studies, including systematic reviews with meta-analysis, show a significant correlation between high-endoscopy/ERCP center volume and overall procedural success, as well as fewer complications. Swedish register data from GallRiks also demonstrates that higher case volumes at both the endoscopist and center levels lead to better cannulation success rates and fewer complications.

In patients with malignant biliary obstruction who are not undergoing curative surgery, a large English cohort study found an association between high-volume ERCP centers and lower 30-day mortality, as well as fewer re-ERCP procedures.

However, there are no published Danish studies directly comparing complication rates between high and low-volume ERCP centers, such as regional hospitals versus highly specialized HPB centers. This makes it impossible to quantify differences or identify organizational or technical causes of potential variation in complication rates across Danish hospitals.

Thus, there is a clinical and health policy need for a systematic, national investigation into ERCP complications, comparing rates between high and low-volume centers to guide quality improvements and potential centralization needs.