Skip to main content
SpringerLink
Log in

Enseignement de la prise en charge endoscopique des hémorragies digestives

Training in endoscopic hemostasis

  • Mise au Point / Update
  • Published:
Acta Endoscopica

Résumé

L’hémorragie digestive est un événement imprévisible et grave nécessitant une prise en charge en urgence. L’hémostase endoscopique est définie par l’arrêt du saignement et la prévention de la récidive hémorragique par l’application d’une ou plusieurs techniques d’hémostase endoscopique. L’apprentissage des techniques d’hémostase est rendu complexe du fait du caractère urgent, grave et imprévisible du saignement digestif. Le seul enseignement par compagnonnage est donc long, difficile et aléatoire en fonction des cas rencontrés lors de sa formation initiale. La prise en charge des hémorragies digestives nécessite de connaître les principes de leur prise en charge type réanimation ou médicale plus globale, de connaître les causes potentielles de saignement et leurs traitements endoscopiques dédiés, et d’avoir les compétences techniques pour réaliser une endoscopie. Plusieurs outils de simulation, à savoir simulateur et modèles animaux, sont disponibles et fiables dans l’apprentissage de l’hémostase endoscopique. Cependant, des critères précis de validation et de consolidation de l’apprentissage des techniques d’hémostase endoscopique sont encore nécessaires.

Abstract

Gastrointestinal bleeding is an unprevisible and serious event requiring urgent management. Endoscopic hemostasis is defined by the cessation of bleeding and prevention of rebleeding by applying one or more technical endoscopic hemostatic techniques. It is an advanced procedure. Training in endoscopic hemostasis is difficult partly due to the urgent and unpredictable condition of gastrointestinal bleeding. Training by tutoring only (performing clinical cases under the supervision of a trainee) is long and difficult because it depends on the clinical cases seen during fellowship. Endoscopic management of GI hemorrhage includes important knowledge in medical management, in systematic categorization of both source of bleeding and the technique used to control it, and basic knowledge about technical skills to perform endoscopic procedure. Various simulation platforms, including virtual reality simulators, and animal models are available and efficient for training in endoscopic hemostasis. However, validated criteria for obtaining and maintaining procedural competence in endoscopic hemostasis techniques are still lacking.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010;152:101–113.

    Article  PubMed  Google Scholar 

  2. Kovacs TO, Jensen DM. Recent advances in the endoscopic diagnosis and therapy of upper gastrointestinal, small intestinal, and colonic bleeding. Med Clin North Am 2002;86:1319–1356.

    Article  PubMed  Google Scholar 

  3. De Franchis R, Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010;54:762–768.

    Article  Google Scholar 

  4. Rockall TA, Logan RF, Devlin HB, Northfield TC. Selection of patients for early discharge or outpatient care after acute upper gastrointestinal haemorrhage. National Audit of Acute Upper Gastrointestinal Haemorrhage. Lancet 1996;347:1138–1140.

    CAS  Google Scholar 

  5. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000;356:1318–1321.

    Article  PubMed  CAS  Google Scholar 

  6. Matthes K. Simulator training in endoscopic hemostasis. Gastrointest Endosc Clin N Am 2006;16:511–527.

    Article  PubMed  Google Scholar 

  7. Gerson LB. Evidence-based assessment of endoscopic simulators for training. Gastrointest Endosc Clin N Am 2006;16:489–509.

    Article  PubMed  Google Scholar 

  8. Parra-Blanco A, González N, González R, Ortiz-Fernández-Sordo J, Ordieres C. Animal models for endoscopic training: do we really need them? Endoscopy 2013;45:478–484.

    Article  PubMed  CAS  Google Scholar 

  9. Directive 2010/63/EU of the European Parliament and of the Council of 22 September 2010 on the protection of animals used for scientific purposes. Official Journal of the European Union available on: http://eur-lex.europa.eu/LexUriServ/LexUri-Serv.do?uri=OJ:L:2010:276:0033:0079:FR:PDF

  10. Hochberger J, Neumann M, Hohenberger W, Hahn EG. EASIEErlangen Education Simulation Model for Interventional Endoscopy—a new bio-training model for surgical endoscopy. Biomed Tech 1997;42(Suppl):334.

    Article  Google Scholar 

  11. Hochberger J, Maiss J. Currently available simulators: ex vivo models. Gastrointest Endosc Clin N Am 2006;16:435–449.

    Article  PubMed  Google Scholar 

  12. Neumann M, Hochberger J, Felzmann T, Ell C, Hohenberger W. Part 1. The Erlanger endotrainer. Endoscopy 2001;33:887–890.

    Article  PubMed  CAS  Google Scholar 

  13. Hochberger J, Euler K, Naegel A, Hahn EG, Maiss J. The compact Erlangen Active Simulator for Interventional Endoscopy: a prospective comparison in structured team-training courses on “endoscopic hemostasis” for doctors and nurses to the “Endo-Trainer” model. Scand J Gastroenterol 2004;39:895–902.

    Article  PubMed  CAS  Google Scholar 

  14. Haycock AV, Youd P, Bassett P, Saunders BP, Tekkis P, Thomas-Gibson S. Simulator training improves practical skills in therapeutic GI endoscopy: results from a randomized, blinded, controlled study. Gastrointest Endosc 2009;70:835–845.

    Article  PubMed  Google Scholar 

  15. Maiss J, Prat F, Wiesnet J, Proeschel A, Matthes K, Peters A, et al. The complementary Erlangen active simulator for interventional endoscopy training is superior to solely clinical education in endoscopic hemostasis—the French training project: a prospective trial. Eur J Gastroenterol Hepatol 2006;18:1217–1225.

    Article  PubMed  Google Scholar 

  16. Hochberger J, Maiss J, Magdeburg B, Cohen J, Hahn EG. Training simulators and education in gastrointestinal endoscopy: current status and perspectives in 2001. Endoscopy 2001;33:541–549.

    Article  PubMed  CAS  Google Scholar 

  17. Martinek J, Suchanek S, Stefanova M, Rotnaglova B, Zavada F, Strosova A, et al. Training on an ex vivo animal model improves endoscopic skills: a randomized, single-blind study. Gastrointest Endosc 2011;74:367–373.

    Article  PubMed  Google Scholar 

  18. Hochberger J, Matthes K, Maiss J, Koebnick C, Hahn EG, Cohen J. Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone. Gastrointest Endosc 2005;61:204–215.

    Article  PubMed  Google Scholar 

  19. Johnston JH, Jensen DM, Auth D. Experimental comparison of endoscopic yttrium-aluminum-garnet laser, electrosurgery, and heater probe for canine gut arterial coagulation. Importance of compression and avoidance of erosion. Gastroenterology 1987; 92:1101–1108.

    PubMed  CAS  Google Scholar 

  20. Chen VK, Marks JM, Wong RCK, McGee MF, Faulx AL, Isenberg GA, et al. Creation of an effective and reproducible nonsurvival porcine model that simulates actively bleeding peptic ulcers. Gastrointest Endosc 2008;68:548–553.

    Article  PubMed  Google Scholar 

  21. Chiu PW, Hu B, Lau JY, Sun LC, Sung JJ, Chung SS. Endoscopic plication of massively bleeding peptic ulcer by using the Eagle Claw VII device: a feasibility study in a porcine model. Gastrointest Endosc 2006;63:681–685.

    Article  PubMed  Google Scholar 

  22. Hu B, Chung SC, Sun LC, Lau JY, Kawashima K, Yamamoto T, et al. Developing an animal model of massive ulcer bleeding for assessing endoscopic hemostatic devices. Endoscopy 2005;37: 847–851.

    Article  PubMed  CAS  Google Scholar 

  23. Jensen DM, Machicado GA. Hemoclipping of chronic canine ulcers: a randomized, prospective study of initial deployment success, clip retention rates, and ulcer healing. Gastrointest Endosc 2009;70:969–975.

    Article  PubMed  Google Scholar 

  24. Jensen DM, Machicado GA, Hirabayashi K. Randomized controlled study of 3 different types of hemoclips for hemostasis of bleeding canine acute gastric ulcers. Gastrointest Endosc 2006;64:768–773.

    Article  PubMed  Google Scholar 

  25. Jutabha R, Jensen DM, Machicado G, Hirabayashi K. Randomized controlled studies of injection Gold Probes compared with monotherapies for hemostasis of bleeding canine gastric ulcers. Gastrointest Endosc 1998;48:598–605.

    Article  PubMed  CAS  Google Scholar 

  26. Sung JJ, Luo D, Wu JC, Ching JY, Chan FK, Lau JY, et al. Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy 2011;43:291–295.

    Article  PubMed  CAS  Google Scholar 

  27. Camus M, Marteau P, Pocard M, Bal Dit Sollier C, Lavergne-Slove A, Thibault A, et al. Validation of a live animal model for training in endoscopic hemostasis of upper gastrointestinal bleeding ulcers. Endoscopy 2013;45:451–457.

    Article  PubMed  CAS  Google Scholar 

  28. American College of Graduate Medical Education (ACGME). General Program Requirements for Fellowship Education in Gastroenterology. Available: acgme.org (accessed July 1, 2007).

Download references

Author information

Authors and Affiliations

  1. service de gastroentérologie, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris 7, 2 rue Ambroise Paré, F-75010, Paris, France

    M. Camus, X. Dray & P. Marteau

Authors
  1. M. Camus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. X. Dray
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Marteau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Camus.

About this article

Cite this article

Camus, M., Dray, X. & Marteau, P. Enseignement de la prise en charge endoscopique des hémorragies digestives. Acta Endosc 43, 275–282 (2013). https://doi.org/10.1007/s10190-013-0348-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10190-013-0348-7

Mots clés

Keywords

Search

Navigation