-
Post-polypectomy colorectal bleeding: current strategies and the way forward
-
Nilanga Nishad, Mo Hameed Thoufeeq
-
Clin Endosc 2025;58(2):191-200. Published online November 27, 2024
-
DOI: https://doi.org/10.5946/ce.2024.241
-
-
 Abstract
 PDF PubReader ePub
- Post-endoscopic mucosal resection (EMR) bleeding, or clinically significant post-EMR bleeding, is influenced by factors such as polyp size, right-sided colonic lesions, laterally spreading tumors, anticoagulant use, and comorbidities like cardiovascular or chronic renal disease. The optimal prophylactic therapy for post-EMR bleeding remains unknown, with no consensus on specific criteria for its application. Moreover, prophylactic measures, including clipping, suturing, and coagulation, have produced mixed results. Selective clipping in high-risk patients is cost-effective, whereas universal clipping is not. Studies and meta-analyses indicate that routine prophylactic clipping does not generally reduce post-polypectomy bleeding but may be beneficial in cases of large proximal lesions. Some studies have revealed that the post-polypectomy bleeding risk after EMR of transverse colonic lesions is lower than that of the ascending colon and caecum, suggesting limited efficacy of clipping in the transverse colon. Cost-effectiveness studies support selective clipping in high-risk groups, and newer static agents such as PuraStat are alternatives; however, their cost-effectiveness is undetermined. Further research is required to establish clear guidelines and refine prophylactic strategies to prevent post-EMR bleeding.
-
Advancing colonoscopy training: tailored strategies and simulation-based models for skill mastery
-
Nilanga Nishad, Malith Nandasena, Andreas Hadjinicolaou, Mo Hameed Thoufeeq
-
Received January 13, 2025 Accepted March 9, 2025 Published online April 24, 2025
-
DOI: https://doi.org/10.5946/ce.2025.019
-
-
Abstract
PubReaderePub
- Effective endoscopy training begins by assessing the trainee’s experience and identifying their skill level: beginners, learners, independent practitioners, or experts. Beginners focus on basic tasks, such as cecal intubation, while advanced trainees refine efficiency and complex techniques. Training prioritizes conscious competence through deliberate practice, reflection, and verbalizing actions; this enhances mindfulness and procedural expertise. Clear communication, standardized terminology, and constructive feedback ensure safety, confidence, and skill retention. SMART objectives—specific, measurable, achievable, relevant, and timely—help structure sessions for skill development and mastery. Simulation-based models support training at all the levels. Beginners benefit from cost-effective low-fidelity bench models and virtual reality (VR) simulators, which offer realistic tactile feedback and customizable scenarios. Studies have shown that both low- and high-fidelity models can effectively teach basic skills, although VR is preferred for foundational training. Advanced trainees utilize animal-based models for therapeutic interventions, three-dimensional printed models for pathology-specific practice, and hybrid models that combine VR and physical elements for enhanced realism. Augmented reality and haptic feedback systems refine advanced skills, but face developmental and cost challenges. Mentored live patient models excel in real-world decision-making, but raise ethical concerns. Training is tailored to individual needs, and Competency-Based training ensures mastery at each stage, from beginners to advanced practitioners.
|
KSGE
