Aabakken, Lars

ABSTRACT Telemedicine is a broad term that encompasses all aspects of utilizing information and communication technologies to provide health services at distant sites. The primary goal of telementoring is the education and training of gastrointestinal (GI) endoscopists particularly in areas where there is a shortage of endoscopy trainers. Telementoring in GI endoscopy can help to provide teaching and skills training both in simulator‐based learning, and endoscopic skills training in the context of patient care. This position statement aims to outline the role of telementoring within GI endoscopy, offering a general model for the introduction and evaluation of a telementoring program that incorporates both simulators for junior trainees and skills training for practicing endoscopists. We hope to highlight its utility and implementation in remote locations. WEO recognizes that telementoring is valuable to expand access to high‐quality endoscopy training especially in parts of the world where there is a shortage of endoscopy trainers and this document can serve as a guide in the planning and implementation of telementoring programs.

Recent guidelines on biliary cannulation are lacking. This guideline is an initiative of the World Endoscopy Organization (WEO) with the involvement of a panel of experts from Asia, Europe, and America. Relevant clinical questions on four areas (post‐endoscopic retrograde cholangiopancreatography [ERCP] pancreatitis [PEP] prophylaxis, biliary cannulation techniques, sphincterotomy/papillary balloon dilation, and biliary cannulation in special circumstances) were developed and answered after systematic reviews of the literature and using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Successful biliary cannulation and sphincterotomy are cornerstones of ERCP and are indispensable for almost all therapeutic and advanced diagnostic procedures. However, adverse events, particularly PEP, may commonly occur and impair patients' outcomes. A high cannulation rate and a low rate of PEP are quality indicators for ERCP and should be the goal of all endoscopists. With this guideline we aimed to provide clinical practice advice applicable worldwide, regardless of resources and expertise availability. The main recommendations focus on specific aspects of ERCP, including pre‐, intra‐, and postprocedural measures to reduce the risk of PEP, the technique for an initial biliary cannulation attempt, options for cannulation in cases of difficult biliary access, alternatives to ERCP in case of failure (percutaneous‐ and endoscopic ultrasound‐guided), and biliary access in altered anatomy (periampullary diverticulum and postsurgical anatomy) and in the presence of duodenal stenosis.