Introduction Much concern surrounds Gastroenterology Specialist Registrar(StR) endoscopy training, especially in regards to endoscopic management of Acute Upper Gastrointestinal Bleeding (AUGIB). Recent evidence suggests there has been a decline in exposure and experience in AUGIB endoscopy.1 In July 2013 our Hospital introduced a Consultant led and Registrar supported Monday to Friday, 9 to 5 pm in-reach service. It comprises of a morning visit to the acute medical units and a daily inpatient emergency list. This study looked at registrar AUGIB endoscopy training after its implementation.
Methods Endoscopy reports of patients presenting with haematemesis, melena or both who had undergone gastroscopy during the period of 1st of March 2015 to 31st August 2015 were retrieved using the endoscopy reporting tool Unisoft and were then analysed. Reports where StRs were the primary operator were considered. Number of procedures, haemostatic intervention and nature of haemostasis was analysed. This was then compared to data from the year before implementation (01/03/2012 to 31/08/2012).
Results A total of 7 StRs (5 Full Time and 2 Less than Full Time) performed gastroscopies on AUGIB patients as first operators under Consultant supervision. Over the 6 month period a total of 166 gastroscopies were undertaken(Mean 24). On 26 occasions, endoscopic intervention(EI) was performed(Mean 4). On average, 16% of the AUGIB patients required EI. In cases of Non Variceal Bleeding, Dual therapy was applied in 87.5% of the cases. In the remaining cases Haemospray was used. On average each StR was able to perform one case of oesophageal variceal banding and one case where Haemospray was utilised. Data from the 2012 cohort in comparison showed a total of 66 gastroscopies over 6 months with 13 EI by 5 StRs. On average 13 procedures and 2.6 EIs were performed by each StR.Dual therapy was applied in only 28.5% of the cases.
Conclusion The introduction of the Registrar of the Week Service provides a valuable opportunity for StRs to be trained in endoscopic haemostasis and acquire exposure to AUGIB patients. As per this study each StR on an average performed endoscopy on 24 AUGIB patients. If this is extrapolated, each StR will be able to perform 48 procedures in 1 year and 240 procedures over 5 years. In the case of EI, on average a StR can perform around 4 interventions over 6 months, which comes to 8 per year and 40 in a 5 year programme which is significantly better than in the previous cohort and other centres.1 Hospitals should consider developing similar services not only to meet demands for 24/7 Consultant led AUGIB endoscopy service but provide adequate endoscopic training provision for current specialist registrars in order to ensure future competent and confident Consultants.
Reference 1 Penny HA, Kurien M, Wong E, et al. Frontline Gastroenterology 2016;7:67–72.
Disclosure of Interest None Declared
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