Training in endoscopic haemostasis: targeting the bleeding point

摘要

Providing effective endoscopic therapy for patients with acute upper gastrointestinal bleeding (AUGIB) is a core activity for almost all gastroenterologists. AUGIB still carries a mortality rate of up to 10% and increasingly occurs in older, comorbid patients taking antithrombotic agents and, thus, their management can be complex. Despite this, there is as yet no structured pathway for training in endoscopic haemostasis. Two related papers in Frontline Gastroenterology examine gastroenterology trainees’ experience of training in therapeutic endoscopy for bleeding and explore potential barriers to achieving competence and confidence in this. Siau et al examined the JETS database—an e-logbook used by UK trainees to record procedures undertaken during training.1 Of 241 trainees over a 3-year period, 232 used the JETS system to record almost 13 000 procedures with a median of 42 cases each (IQR: 21–71) involving therapy for upper GI bleeding, most commonly epinephrine injection and variceal ligation. There was, however, significant regional variation across the UK with trainees’ case experience ranging from 20 to 126 across the 19 deaneries. This was a retrospective study looking at self-reported entries on the JETS database. Therefore, it is possible that it underestimates the true number of cases performed during training as not all may have been recorded. It also only records procedures performed during the defined training period and perhaps not those that may occur after the award of a Certificate of Completion of Training (CCT) or those performed if a trainee goes ‘out of programme’ for example, to undertake research or an advanced fellowship. In addition, the JETS database does not record the quality or success of haemostasis. Despite these limitations, the wide variation in trainees’ exposure to therapeutic haemostatic procedures across the different deaneries in the UK is of potential concern.