Dear reader, The current issue of Revista Española de Enfermedades Digestivas includes an interesting article by JM Riesco et al. entitled “Efficacy and safety of ERCP in a low- volume hospital” (1). The Editorial Board of the journal wants to highlight this man- uscript, not only for its high scientific level but also because of its clinical relevance and the controrversy it entails. The authors –who had no previous experience in per- forming endoscopic retrograde cholangiopancreatography (ERCP) and work in a low- volume institution (fewer than 100 ERCPs/year)– show in this elegant study their learning curve with this technique. The results from the aforementioned study suggest that, should one adhere to the training recommendations published (2,3), the efficacy and safety levels described in the literature for ERCP may be reached. Although one may find recommendations on this subject in the literature, different opinions exist regarding who should perform complicated techniques like ERCP, and which should be the minimum requirements needed by a hospital and/or an endoscopist in order to perform this highly complex technique with potential complications. These questions arise on each occasion this subject is discussed, and we hope that the argu- ments provided by Dr. López-Rosés and Dr. Rodríguez-Muñoz for and against –respec- tively– the performance of these complex techniques in low-volume institutions with little experience will help us determine whether this type of procedure is to be con- sidered a “one-size-fits-all” approach or otherwise reserved for hospitals where expe- rience does exist and volume is adequate in order to ensure success. Finally, in dealing with these issues we think aloud and raise the matter of credentialing endoscopy units and endoscopists performing these complicated techniques, and then auditing their results and complications periodically. Certainly, despite expert opinions, we believe that future interventions should point in that direction to secure our patients maximal guarantees. ERCP in low-volume hospitals – Arguments for (Leopoldo López-Rosés) ERCP represents one of the most complex digestive endoscopy techniques; it has a long learning curve, and is associated with a significant risk for complications, some of them severe or even lethal. However, due to its clinical usefulness, ERCP has pro- gressively become widespread and is presently performed not only in big referral cen- ters but also in smaller institutions with a low volume of patients. Determining who is really capable of performing ERCP, and which hospitals should be licensed to do it, is no doubt a requirement. It seems reasonable that not every endoscopist or hospital should be granted privileges to perform this procedure. On the one hand, apart from ERCP in a low-volume hospital. Arguments “for” and “against” this type of practice 1130-0108/2013/105/2/61-67 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS Copyright © 2013 ARÁN EDICIONES, S. L. REV ESP ENFERM DIG (Madrid) Vol. 105, N.° 2, pp. 61-67, 2013 E d i t o r i a l