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Variation in exposure to endoscopic haemostasis for acute upper gastrointestinal bleeding during UK gastroenterology training
  1. Keith Siau1,2,
  2. A John Morris1,3,
  3. Aravinth Murugananthan1,4,
  4. Brian McKaig4,
  5. Paul Dunckley1,5
  1. 1 Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
  2. 2 Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  3. 3 Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
  4. 4 Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  5. 5 Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
  1. Correspondence to Dr Keith Siau, Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London NW1 4LE, UK; keithsiau{at}


Introduction 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.

Methods 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.

Results 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.

Conclusion 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.

  • gastrointesinal endoscopy
  • gastrointestinal bleeding

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  • Twitter @drkeithsiau, @@PaulDunckley

  • Presented at British Society of Gastroenterology 2019

  • Contributors Study conception: KS, JM, AM, BM, PD. Statistical analyses: KS. Initial draft of manuscript: KS. Critical revisions: KS, JM, AM, BM, PD.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors are affiliated with the Joint Advisory Group on Gastrointestinal Endoscopy.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article

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