Curriculum on management of acute upper gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Voiosu A.M.; Camus M.; Ibrahim M.; Gyökeres T.; Cardoso R.; Fukuchi T.; Kurek K.; Lala V.; Laursen S.B.; Murino A.; Pawlak K.M.; Siau K.; Slattery E.; Soriani P.; Tringali A.; Tziatzios G.; Wannhoff A.; Debels L.K.; Tate D.J.; Tham T.C.; Gralnek I.M.

Journal: Endoscopy

Publisher: Georg Thieme Verlag

Publication Date: 14 July 2026

Volume / Issue: Volume 58 / Issue 9

Pages: 1039–1055

ISSN: 0013726X

DOI: 10.1055/a-2893-6920

Scopus: View on Scopus

PubMed: 42447876

Document Type: Article

Access: All Open Access; Bronze Open Access

Authors and Affiliations

Voiosu A.M., Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Camus M., Endoscopic Center, Sorbonne University, Saint Antoine Hospital, Aphp, Paris, France; Ibrahim M., Theodor Bilharz Research Institute, Giza, Egypt; Gyökeres T., Central Hospital of Northern Pest, Military Hospital, Budapest, Hungary, Center of Translational Medicine, Semmelweis University, Budapest, Hungary; Cardoso R., Gastroenterology Department, Viseu Dão-Lafões Local Health Unit, Viseu, Portugal; Fukuchi T., Department of Gastroenterology, Fujisawa City Hospital, Fujisawa-City, Kanagawa, Japan; Kurek K., Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, Białystok, Poland; Lala V., University of the Witwatersrand Johannesburg, Johannesburg, South Africa, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa, Wits Donald Gordon Medical Centre, Johannesburg, South Africa; Laursen S.B., Department of Gastroenterology, University of Southern Denmark, Odense, Denmark, Department of Gastroenterology, Odense University Hospital, Odense, Denmark; Murino A., Royal Free Unit for Endoscopy, The Royal Free Hospital, London, United Kingdom, University College London, London, United Kingdom; Pawlak K.M., Gastroenterology Department, Hospital of the Ministry of Interior and Administration, Torun, Poland, Gastroenterology and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University, Ludwik Rydygiers Provincial Integrated Hospital, Torun, Poland; Siau K., Gastroenterology, Royal Cornwall Hospitals Nhs Trust, Truro, United Kingdom, Immunology and Immunotherapy, University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom; Slattery E., Department of Gastroenterology, University Hospital Galway, Galway, Ireland, School of Medicine, University of Galway, Galway, Ireland; Soriani P., Gastroenterology and Digestive Endoscopy Unit, Azienda Usl Modena, Modena, Italy; Tringali A., Uoc Gastroenterologia, Ulss 2 - Marca Trevigiana, Ospedale Conegliano, Conegliano, Italy; Tziatzios G., Agia Olga General Hospital of Nea Ionia-Konstantopouleio, Athens, Greece; Wannhoff A., Department of Gastroenterology Haemato-Oncology and Infectious Diseases, Rkh Klinikum Ludwigsburg, Ludwigsburg, Germany; Debels L.K., Gastroenterolgy and Hepatology, Uz Brussel, Brussels, Belgium; Tate D.J., Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium, Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Tham T.C., Division of Gastroenterology, Ulster Hospital, Belfast, United Kingdom; Gralnek I.M., Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel, Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel

Abstract

1 Before commencing hands-on upper gastrointestinal bleeding (UGIB) training, trainees should have thorough knowledge of: pathology, vascular anatomy, technical use of devices, clinical care pathways, and all relevant components of pre-, intra-, and postprocedural patient care. 2 Preadoption technical skills required for training in the management of UGIB include adequate scope handling, intubation technique, washing and suctioning of residue, mucosal examination, and handling of accessories. 3 Preadoption technical skills required for training in the management of UGIB should be assessed individually based on a competency framework and not solely on numerical thresholds. 4 The integrative skills required for the management of UGIB do not essentially differ from those needed in other endoscopic procedures and should include adequate situational awareness, collaboration, team leadership, and patient communication in order to ensure short- and long-term goals are achieved. 5 The trainee should reach minimum recommended standards for key performance indicators in upper GI endoscopy before starting training in the management of UGIB. 6 Attendance of at least one half-day training session on a dedicated simulator that provides GI bleeding training at the beginning of training for management of UGIB is advised. 7 Trainees should be supervised directly and carefully during UGIB training for a minimum of 20 procedures with endoscopic stigmata of recent hemorrhage in order to prevent failure of hemostasis and ensure adequate trainee skill acquisition. 8 Trainers should take into account pre-endoscopic and intraprocedural factors predicting outcome, technical complexity, and risk of hemostatic failure when deciding appropriateness and degree of trainee involvement in case management. 9 During their training, trainees should be exposed to all hemostatic modalities, as per ESGE guideline recommendations, and the opportunities for teaching arising from the specifics of each UGIB case. 10 Trainers should use successful hemostasis, defined as the absence of any further bleeding (persistent or recurrent bleeding), as the ultimate goal of training in the endoscopic management of UGIB. 11 Patients with recurrent bleeding should be treated by experienced endoscopists or by a trainee under their direct supervision owing to the higher risk of failure of conventional endoscopic treatment. 12 Trainers who are teaching management of UGIB should fulfil the same standards as any trainer of basic endoscopy procedures. 13 Trainees should be exposed to multidisciplinary team discussions and care pathways for failed endoscopic treatment of UGIB. 14 Training centers with limited UGIB case volumes are encouraged to offer short-term immersive training in centers with high volume caseloads of UGIB in order to ensure sufficient exposure for trainees. 15 Competency in managing UGIB is defined as the ability to assess the need for endoscopy, and plan and carry out successful hemostasis. 16 Trainees should manage an indicative number of 30 cases in which successful hemostasis is achieved before evaluation of competence in management of UGIB. 17 UGIB-CAT is advised as a formative assessment tool during training to track acquisition of competence and provide trainee feedback. 18 Trainees should undergo a formal summative assessment of competence in managing UGIB during their training. 19 Endoscopists should continue a period of tracking results and mentored practice with an experienced colleague for at least 6 months after achieving competence in managing UGIB. 20 As trainees move to independent practice, they should have established access to or referral pathways for key supporting specialties involved in the nonendoscopic management of acute UGIB (including emergency medicine, surgery, and interventional radiology). © 2026 Georg Thieme Verlag. All rights reserved.

Keywords

Acute Disease; Clinical Competence; Curriculum; Education, Medical, Graduate; Endoscopy, Gastrointestinal; Europe; Gastroenterology; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; diagnosis; education; endoscopic hemostasis; gastrointestinal endoscopy; human; medical education; practice guideline; procedures; therapy

Citation Information

Scopus Citations: 0

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