There Is No Excuse for Mortality Due to Lack of Competency and Training of Paediatric Endoscopists in Gastrointestinal Bleeding Therapy in 2018

Abstract

Acute upper gastrointestinal bleeding in children is possibly the last medical emergency which continues to lead to the death of a child due to the lack of competency/clinical judgement of the doctor, as opposed to the disease itself, leading to mortality despite optimum medical intervention. This is unacceptable in any circumstances in 2018. It occurs due to a number of conspiring factors including lack of appreciation of the clinical presentation requiring urgent endoscopic intervention; misapprehension of the urgency of timing required of such an intervention predicated on the severity of the gastrointestinal (GI) bleed; lack of application of a paediatric-specific validated score predicting for such endoscopic intervention; lack of skill in endo-haemostatic intervention techniques by paediatric endoscopists; poor training in such techniques among paediatric endoscopists; paucity of cases with lack of exposure of the paediatric endoscopist regularly to enable skills to be maintained, once acquired; reluctance of adult endoscopists in many centres to support paediatric GI bleeding services. In essence then the paediatric GI community urgently needs to identify centres of excellence to whom these children should be transferred. Transfer is safe in all but the most critical cases once stabilised with transfusion, octreotide/terlipressin and iv proton pump inhibitors. The resources are country-dependent but this is really no excuse. We must not let this parlous state of affairs continue. Solutions are explored in this article and please let this serve as a call to action for all those involved in this continuing debacle in order to save “save-able” lives.

Urgent endoscopy in children: epidemiology in a large region of France

“…A recent survey of pedia-tric endoscopy in the UK pointed out that only 50 % of tertiary centers for pediatric endoscopy could provide a valuable service to face upper GI bleedings [2]. This important issue is exhaustively addressed in a recent review [3].…”

Paediatric gastroenterology fellows’ self‐assessment of endoscopy skills

“…Multiple studies have shown that the number of procedures in the paediatric population is not sufficient to reach the minimum number of procedures recommended to reach competency . In 2018, Thomson et al reported a lack of endoscopy training and knowledge to adequately treat gastrointestinal bleeds in the paediatric population in Europe leads to increased mortality of ‘save‐able’ lives . Questions regarding this phenomenon remain in paediatric gastroenterology.…”