Advanced biliary cannulation masterclasses improve self-reported knowledge and teaching confidence in needle-knife fistulotomy

Background and Aims Needle-knife fistulotomy (NKF) is widely used for difficult biliary access, yet formal training is inconsistent and teaching confidence remains low. We aimed to characterise baseline NKF experience among independent ERCP practitioners and evaluate the self-reported educational impact of a national advanced biliary cannulation masterclass series. Materials and Methods Ten one-day masterclasses were delivered for 152 independent ERCP practitioners, combining video-based case discussion, didactic teaching and supervised hands-on simulator training. Pre-course questionnaires captured baseline NKF use. Post-course questionnaires used a retrospective before/after format across six cannulation domains. Wilcoxon signed-rank tests were applied. Results Of 126 pre-course respondents, 82.5% had used NKF but only 33.3% had received formal training and 27.0% had trained a trainee. Prospective pre-course NKF knowledge was 5.8/10 and teaching confidence was 3.7/10. On retrospective post-course assessment (n=122), median NKF knowledge increased from 5/10 (IQR 4–7) to 9/10 (IQR 8–9; p<0.001) and teaching confidence from 4/10 to 7/10 (p<0.001); the proportion rating ≥7/10 rose from 14% to 53%. Post-course, 94.3% intended to use NKF more often and 79.8% would consider primary fistulotomy in selected cases. Conclusions NKF is commonly used despite limited formal training and low teaching confidence. A national masterclass series was associated with improvements in self-reported knowledge and teaching confidence. A planned longitudinal prospective audit will determine whether these gains translate into changes in practice and patient outcomes.