Training in GI Hemostasis

The Importance of Arterial Blood Flow Detection for Risk Stratification and Eradication to Achieve Definitive Hemostasis of Severe Non-Variceal UGI Hemorrhage

“…Furthermore, there are other limitations of OTSCs and their deployment. The OTSCs are more expensive than standard hemoclips, MPEC, or DEPs, additional expertise is needed to successfully deploy OTSC onto the SRH of lesions with severe NVUGIH, and there is a moderate learning curve which requires the performance of several emergency treatments to be competent [14,32,33]. Accurate deployment of OTSCs onto the SRH for definitive hemostasis of fundal gastric lesions in retroflexion, angulated anastomotic ulcers, and duodenal bulbar ulcers can also be especially challenging [14,33].…”

“…As a reported example of complications, OTSC can cause stenosis of the lumen and obstruction if applied in a narrow lumen [33]. Through-the-scope hemostasis treatments do not have the same limitations of OTSC in terms of strictures (smaller endoscopes can be used and dilatation can be performed), training (MPEC and HCs are easy to use; DEP is easy to learn), and expense [14,32].…”

“…There needs to be a concerted effort by GI training program directors, GI endoscopists, and GI endoscopic societies. The training about NVUGIH should be improved in several ways [32]. These include incorporating new cognitive and technical training about the vascular anatomy of different GI lesions that cause severe GIH; teaching about and utilizing DEP monitoring along with visual SRH to refine and improve endoscopic risk stratification into major and lesser SRH of focal NVUGI lesions; and utilizing DEP-guided hemostasis, OTSC, and other new effective methods for definitive hemostasis of patients with severe NVUGIH with major SRH and also other patients with severe rebleeding.…”

“…Standard visually guided treatments are effective for lesser SRH (e.g., oozing bleeding (Forrest IB) or flat spots (FIIC) and endoscopists should be encouraged to utilize these. This training will depend upon a renewed emphasis by GI societies on GI hemorrhage, updating guidelines for clinicians on vascular anatomy and risk stratification, and most of all, on skilled bedside training by experienced endoscopists and teachers who want to improve patient outcomes for all types of GI hemorrhage, including NVUGIH [32]. Informed Consent Statement: Informed consent was obtained from all subjects involved in the studies.…”