El Chafic, Abdul; Romero, Ricardo V.; Shah, Janak N.
Advanced endoscopic retrograde cholangiopancreatography (ERCP) ductal access techniques require a higher level of skill compared to standard ERCP access maneuvers. These techniques are used in cases of standard ERCP access failures and include dual-wire techniques and precut papillotomy. Interventional endoscopic ultrasound (EUS) procedures requiring a higher level of technical skill as compared to more basic EUS procedures (eg, diagnostic EUS and EUS-fine needle aspiration) include EUS-guided drainage of pancreatic fluid collections, EUS-guided pancreaticobiliary ductal access and drainage, and EUS-guided vascular interventions. In this article, we review techniques and outcomes of advanced ERCP access techniques and of interventional EUS procedures. Issues related to training in these techniques, assessing competency in these procedures, and incorporating these highly complex and higher-risk procedures into endoscopic practice are also discussed. (C) 2017 Elsevier Inc. All rights reserved.