To control this factor, the training of the person performing the cannulation should be taken into account since the more procedures the gastroenterologist performs the better he or she will perform. Cannulation of the papilla by an experienced physician will likely require fewer attempts than when it is performed by an individual in training. ERCPs must be performed by a gastroenterologist who has been formally trained in this procedure in college. Doctors who take short courses and have no basic endoscopic dexterity should not jump in and perform ERCPs which is to have a high level of complexity in gastroenterology. Use of precuts was required in 14 patients 9.21%. Although no perforations occurred, three of these patients developed pancreatitis 21.43%. There was a significantly greater proportion of these patients among those who developed pancreatitis following ERCPs: p<0.05. Th e risk estimate was 6 times greater for pancreatitis following ERCP with a statistically significant association: OR = 6, 95%CI = 1.31 to 27.3. This finding is related to that presented by other authors who report that precuts are a risk factor in univariate analyses.
Para controlar este factor es muy importante tener en cuenta, como ya lo señalamos, el entrenamiento de la persona que realiza los intentos de canulación, ya que entre mayor número de procedimientos haya realizado el gastroenterólogo tiene una mejor práctica y logra la canulación de la papila en un menor número de inten-tos comparado con un individuo en entrenamiento, de allí la importancia que tengamos en cuenta que la CPRE se debe realizar por un gastroenterólogo con entrenamiento universitario formal en el procedimiento y no por médicos que realizan cursos cortos los cuales no han adquirido ni siquiera la destreza en la endoscopia básica y saltan a realizar la CPRE la cual consideramos nosotros de un alto nivel de complejidad en la gastroenterología.