Endoscopic management of acute gastrointestinal bleeding in children: Time for a radical rethink
Autor: | D Belsha, Mike Thomson |
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Rok vydání: | 2015 |
Předmět: |
medicine.medical_specialty
Gastrointestinal bleeding media_common.quotation_subject Endoscopic management Credentialing Endoscopy Gastrointestinal 03 medical and health sciences Presentation 0302 clinical medicine Excellence Intervention (counseling) medicine Humans 030212 general & internal medicine Child media_common business.industry Acute gastrointestinal bleeding Hemostasis Endoscopic General Medicine medicine.disease Surgery Pediatrics Perinatology and Child Health Acute Disease Tragedy (event) 030211 gastroenterology & hepatology Medical emergency Emergencies business Gastrointestinal Hemorrhage |
Zdroj: | Journal of pediatric surgery. 51(2) |
ISSN: | 1531-5037 |
Popis: | Currently we are no nearer than 10 or 20 years ago providing a safe, adequate, and effective round-the-clock endoscopic services for acute life-threatening gastrointestinal bleeding in children. Preventable deaths are occurring still, and it is a tragedy. This is owing to a number of factors which require urgent attention. Skill-mix and the ability of available endoscopists in the UK are woeful. Manpower is spread too thinly and not concentrated in centers of excellence, which is necessary given the relative rarity of the presentation. Adult gastroenterologists are increasingly reticent regarding their help in increasingly litigious times. Recent work on identification of those children likely to require urgent endoscopic intervention has mirrored scoring systems that have been present in adult circles for many years and may allow appropriate and timely intervention. Recent technical developments such as that of Hemospray® may lower the threshold of competency in dealing with this problem endoscopically, thus allowing lives to be saved. Educational courses, mannequin and animal model training are important but so will be appropriate credentialing of individuals for this skill-set. Assessment of competency will become the norm and guidelines on a national level in each country mandatory if we are to move this problem from the “too difficult” to the “achieved”. It is an urgent problem and is one of the last emergencies in pediatrics that is conducted poorly. This cannot and should not be allowed to continue unchallenged. |
Databáze: | OpenAIRE |
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