Response:

We thank Dr Cotton1 for his insightful comments on the recent American Society for Gastrointestinal Endoscopy (ASGE) guideline document on privileging and credentialing in GI endoscopy as it pertains to competence in ERCP.2 The first issue raised in this letter relates to the number of the ERCPs that a trainee must complete before competency can be assessed and the lack of data on this subject in the published literature. We would like to clarify that the intent of this statement was to ensure that trainees complete at least 200 supervised independent ERCP procedures.

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