Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
BMJ Open Gastroenterol. 2024 Mar 7;11(1):e001281. doi: 10.1136/bmjgast-2023-001281.
The management of upper gastrointestinal bleeding (UGIB) has seen rapid advancements with revolutionising innovations. However, insufficient data exist on the necessary number of emergency endoscopies needed to achieve competency in haemostatic interventions.
We retrospectively analysed all oesophagogastroduodenoscopies with signs of recent haemorrhage performed between 2015 and 2022 at our university hospital. A learning curve was created by plotting the number of previously performed oesophagogastroduodenoscopies with signs of recent haemorrhage against the treatment failure rate, defined as failed haemostasis, rebleeding and necessary surgical or radiological intervention.
The study population included 787 cases with a median age of 66 years. Active bleeding was detected in 576 cases (73.2%). Treatment failure occurred in 225 (28.6%) cases. The learning curve showed a marked decline in treatment failure rates after nine oesophagogastroduodenoscopies had been performed by the respective endoscopists followed by a first plateau between 20 and 50 procedures. A second decline was observed after 51 emergency procedures followed by a second plateau. Endoscopists with experience of <10 emergency procedures had higher treatment failure rates compared with endoscopists with >51 emergency oesophagogastroduodenoscopies performed (p=0.039) or consultants (p=0.041).
Our data suggest that a minimum number of 20 oesophagogastroduodenoscopies with signs of recent haemorrhage is necessary before endoscopists should be considered proficient to perform emergency procedures independently. Endoscopists might be considered as advanced-qualified experts in managing UGIB after a minimum of 50 haemostatic procedure performed. Implementing recommendations on minimum numbers of emergency endoscopies in education programmes of endoscopy trainees could improve their confidence and competency in managing acute UGIB.
上消化道出血（UGIB）的治疗已经有了快速的发展和革命性的创新。然而，对于实现止血干预能力所需的紧急内镜检查数量，目前还缺乏足够的数据。
我们回顾性分析了 2015 年至 2022 年期间在我们大学医院进行的所有有近期出血迹象的食管胃十二指肠镜检查。通过绘制有近期出血迹象的食管胃十二指肠镜检查数量与治疗失败率（定义为止血失败、再出血和必要的手术或放射学干预）的关系曲线，创建了一个学习曲线。
研究人群包括 787 例中位年龄为 66 岁的患者。576 例（73.2%）检测到活动性出血。225 例（28.6%）发生治疗失败。学习曲线显示，在相应内镜医生进行了 9 例食管胃十二指肠镜检查后，治疗失败率显著下降，随后在 20 至 50 例之间出现第一个平台。在进行了 51 例紧急手术之后，观察到第二个下降，随后出现第二个平台。与经验超过 51 例紧急食管胃十二指肠镜检查或顾问医生相比，经验<10 例紧急手术的内镜医生治疗失败率更高（p=0.039）。
我们的数据表明，内镜医生在独立进行紧急手术之前，至少需要进行 20 例有近期出血迹象的食管胃十二指肠镜检查，才能被认为有能力胜任。在进行了至少 50 例止血手术之后，内镜医生可能被认为是管理 UGIB 的高级专家。在内镜培训生的教育项目中实施关于紧急内镜检查最低数量的建议，可以提高他们管理急性 UGIB 的信心和能力。
