Variation in exposure to endoscopic haemostasis for acute upper gastrointestinal bleeding during UK gastroenterology training.
gastrointesinal endoscopy
gastrointestinal bleeding
Journal
Frontline gastroenterology
ISSN: 2041-4137
Titre abrégé: Frontline Gastroenterol
Pays: England
ID NLM: 101528589
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
16
10
2019
revised:
20
11
2019
accepted:
08
12
2019
entrez:
26
10
2020
pubmed:
27
10
2020
medline:
27
10
2020
Statut:
epublish
Résumé
Gastroenterologists are typically expected to be competent in endoscopic haemostasis for acute upper gastrointestinal bleeding (AUGIB), with the Certificate of Completion of Training (CCT) often heralding the onset of participation in on-call AUGIB rotas. We analysed the volume of haemostasis experience recorded by gastroenterology CCT holders on the Joint Advisory Group on Gastrointestinal Endoscopy Training System (JETS) e-portfolio, the UK electronic portfolio for endoscopy, and assessed for variations in exposure to haemostasis. UK gastroenterologists awarded CCT between April 2014 and April 2017 were retrospectively identified from the specialist register. Credentials were cross-referenced with JETS to retrieve AUGIB haemostasis procedures prior to CCT. Procedures were collated according to variceal versus non-variceal therapies and compared across training deaneries. Over the 3-year study period, 241 gastroenterologists were awarded CCT. 232 JETS e-portfolio users were included for analysis. In total, 12 932 haemostasis procedures were recorded, corresponding to a median of 42 (IQR 21-71) per gastroenterologist. Exposure to non-variceal modalities (median 28, IQR 15-52) was more frequent than variceal therapies (median 11, IQR 5-22; p<0.001). By procedure, adrenaline injection (median 12, IQR 6-23) and variceal band ligation (median 10, IQR 5-20) were most commonly recorded, whereas sclerotherapy experience was rare (median 0, IQR 0-1). Exposure to haemostasis did not differ by year of CCT (p=0.130) but varied significantly by deanery (p<0.001), with median procedures ranging from 20-126. Exposure to AUGIB haemostasis during UK gastroenterology training varied across deaneries and procedural modalities which should prompt urgent locoregional review of access and delivery of training. Endoscopy departments should ensure the availability of supportive provisions in haemostasis (i.e. training/upskilling, supervision, mentorship) during the early post-CCT period.
Identifiants
pubmed: 33104080
doi: 10.1136/flgastro-2019-101351
pii: flgastro-2019-101351
pmc: PMC7569517
doi:
Types de publication
Journal Article
Langues
eng
Pagination
436-440Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: All authors are affiliated with the Joint Advisory Group on Gastrointestinal Endoscopy.
Références
Frontline Gastroenterol. 2019 Apr;10(2):93-106
pubmed: 31210174
Frontline Gastroenterol. 2019 Oct;10(4):356-363
pubmed: 31656560
United European Gastroenterol J. 2019 Jul;7(6):798-806
pubmed: 31316784
Curr Treat Options Gastroenterol. 2018 Sep;16(3):345-361
pubmed: 30019105
United European Gastroenterol J. 2019 Apr;7(3):449-450
pubmed: 31019713
J R Coll Physicians Edinb. 2017 Sep;47(3):218-230
pubmed: 29465096
Endosc Int Open. 2019 Apr;7(4):E551-E560
pubmed: 30957005
Frontline Gastroenterol. 2019 Jan;10(1):57-66
pubmed: 30651959
Frontline Gastroenterol. 2017 Jan;8(1):8-12
pubmed: 28839878
Frontline Gastroenterol. 2018 Jul;9(3):200-207
pubmed: 30046424
Frontline Gastroenterol. 2016 Jan;7(1):67-72
pubmed: 28839837