Teaching and pioneering endoscopic retrograde cholangiopancreatography at a tertiary center in Nigeria––Year 1 experience: The apprenticeship model––Is this a viable option for Africa?

Background: Nigeria is a West African country with a population of 190 million. It has approximately 110 endoscopists, of whom two perform endoscopic retrograde cholangiopancreatography (ERCP), with approximately 100 total ERCPs performed over 15 years. There is a perceived need by Nigerian physicians to increase ERCP capacity. Aim: Develop and assess a 1-year ERCP training program in Nigeria using didactics and quarterly formal (“bolus”) hands on training sessions. Materials and Methods: An introductory conference including didactic and hands on sessions was hosted in March 2018. From this introductory conference, six participants were selected for a 1-year training program. The program involved quarterly, in-country, week-long hands-on ERCP sessions. Sessions were led by an experienced interventional gastroenterologist trained and practicing in USA. A multidisciplinary meeting was held on day 1 of each session. Digital communication was used to transmit program information and request patient referrals from medical doctors. Results: ERCP conference attendees included 15 surgical and medical endoscopists, 3 surgical trainees, 3 GI trainees, 6 nurses, 2 anesthesiologists, 1 interventional radiologist and 6 radiology technicians. Six physicians selected for the ongoing 1-year training program include 1 hepatobiliary surgeon, 2 gastroenterologists, 1 gastroenterology fellow and 2 surgical residents. One participant had prior formal ERCP training including 6 weeks hands-on training abroad. There were 109 referrals over 1 year, with an increasing trend over the year. The farthest referral site was almost 900 km away. Conclusion: There is need for ERCP capacity in Nigeria. ERCP is feasible and safe in Nigeria. Awareness amongst healthcare providers to the available procedure resulted in increased patient referral.