British Society of Gastroenterology/Joint Advisory Group on GI Endoscopy Delphi method of consensus recommendations for standardised upper gastrointestinal bleeding haemostasis courses

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Abstract
Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency with estimated one admission every 6 min and an annual incidence of 134 per hundred thousand people in the UK.1 It remains associated with substantial morbidity, mortality and healthcare costs, with contemporary UK data reporting an in-hospital mortality of 8.8%. 2Endoscopic intervention is central to management of AUGIB, providing both diagnostic clarity and definitive haemostatic therapy.3 Timely and effective endoscopic haemostasis reduces ongoing bleeding, rebleeding risk and the need for escalation to surgery or radiological interventions along with appropriate supportive care and pharmacological therapies.4 Modern endoscopic haemostasis encompasses a broad and increasingly complex range of techniques, including injection therapy, thermal coagulation, mechanical methods such as through-the-scope clips and over-the-scope clips and topical haemostatic agents.4 While these advances have improved outcomes in selected high-risk bleeding scenarios, they have also increased the technical and cognitive demands placed on endoscopists, requiring rapid decision-making, device familiarity and procedural competence in high-pressure emergency settings. However, evidence from the UK and international surveys consistently demonstrates significant variability in training exposure and confidence in AUGIB management among gastroenterology trainees.5–7 Compared with diagnostic upper gastrointestinal endoscopy, hands-on experience with haemostatic techniques is limited particularly for advanced or less frequently used interventions. As a result, many trainees report low confidence in managing AUGIB independently at the point of completion of training.5 8 These gaps are compounded by service pressures, exclusion from bleeding rotas and limited access to structured haemostasis training. The gaps are also due to a shortening of the training programme duration through Shape of Training. Professional bodies including the British Society of Gastroenterology (BSG) and the European Society of Gastroenterological Endoscopy advocate competency-based approaches to endoscopy training, emphasising structured curricula, objective assessment and the use of simulation to support skill acquisition.9 Simulation-based training has been shown to improve technical performance and decision-making in haemostasis while minimising patient risk.10 Nevertheless, access to simulation facilities, formalised curricula and standardised haemostasis courses remains inconsistent, and there is currently no agreed national or international framework defining the essential components of AUGIB haemostasis training.

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