Curriculum on management of acute upper gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
Authors
Andrei M. Voiosu, Marine Camus, Mostafa Ibrahim, Tibor Gyökeres, Ricardo Cardoso, Takehide Fukuchi, Krzysztof Kurek, Vikash Lala, Stig Borbjerg Laursen, Alberto Murino, Katarzyna M. Pawlak, Keith Siau, Eoin Slattery, Paola Soriani, Alberto Tringali, Georgios Tziatzios, Andreas Wannhoff, Lynn K. Debels, David J. Tate, Tony C. Tham, Ian M. Gralnek
MAIN RECOMMENDATIONS
- Before commencing hands-on upper gastrointestinal bleeding (UGIB) training, trainees should have thorough knowledge of: pathology, vascular anatomy, technical use of devices, clinical care pathways, and all relevant components of pre-, intra-, and postprocedural patient care.
- Preadoption technical skills required for training in the management of UGIB include adequate scope handling, in tubation technique, washingandsuctioning of residue, mucosal examination, and handling of accessories.
- Preadoption technical skills required for training in the management of UGIB should be assessed individually based on a competency framework and not solely on numerical thresholds.
- The integrative skills required for the management of UGIB do not essentially differ from those needed in other endoscopic procedures and should include adequate situational awareness, collaboration, team leadership, and patient communication in order to ensure short- and Long term goals are achieved.
- Thetrainee should reach minimum recommended stand ards for key performance indicators in upper GI endoscopy before starting training in the management of UGIB.
- Attendance of at least one half-day training session on a dedicated simulator that provides GI bleeding training at the beginning of training for management of UGIB is advised.
- Trainees should be supervised directly and carefully during UGIB training for a minimum of 20 procedures with endoscopic stigmata of recent hemorrhage in order to prevent failure of hemostasis and ensure adequate trainee skill acquisition.
- Trainers should take into account pre-endoscopic and in traprocedural factors predicting outcome, technical complexity, and risk of hemostatic failure when deciding appropriateness and degree of trainee involvement in case management.
- During their training, trainees should be exposed to all hemostatic modalities, as per ESGE guideline recommendations, and the opportunities for teaching arising from the specifics of each UGIB case.
- Trainers should use “successful hemostasis,” defined as the absence of anyfurther bleeding (persistent or recurrent bleeding), as the ultimate goal of training in the endoscopic management of UGIB.
- Patients with recurrent bleeding should be treated by experienced endoscopists or by a trainee under their direct supervision owing to the higher risk of failure of conven tional endoscopic treatment.
- Trainers who are teaching management of UGIB should fulfil the same standards as any trainer of basic endoscopy procedures.
- Trainees should be exposed to multidisciplinary Team discussions and care pathways for failed endoscopic treatment of UGIB.
- Training centers with limited UGIB case volumes are encouraged to offer short-term immersive training in Centers with high volume caseloads of UGIB in order to ensure sufficient exposure for trainees.
- Competency in managing UGIB is defined as the ability to assess the need for endoscopy, and plan and carry out successful hemostasis.
- Trainees should manage an indicative number of 30 cases in which successful hemostasis is achieved before evaluation of competence in management of UGIB.
- UGIB-CAT is advised as a formative assessment tool during training to track acquisition of competence and provide trainee feedback.
- Trainees should undergo a formal summative assessment of competence in managing UGIB during their training.
- Endoscopists should continue a period of tracking results and mentored practice with an experienced colleague for at least 6 months after achieving competence in managing UGIB.
- As trainees move to independent practice, they should have established access to or referral pathways for key supporting specialties involved in the nonendoscopic management of acute UGIB (including emergency medicine, surgery, and interventional radiology.
