Clinical Practice vs. Guidelines: Adherence to ESGE Upper Gastrointestinal Bleeding Management by Young Italian Gastroenterologists. An AGGEI Survey

Aims This study aimed to assess adherence to the European Society of Gastrointestinal Endoscopy (ESGE) [1] [2] recommendations among early-career gastroenterologists regarding UGIB management.

Methods The Italian Association of Young Gastroenterologists and Endoscopists (AGGEI) conducted a 25-question survey among its members from November 2023 to June 2024. The survey covered key ESGE recommendations for UGIB management. 11 questions were on demographics and organizational outcomes, 14 were specifics for EGSE recommendations. Demographic data, including type of hospital and level of expertise, were also collected.

Data analysis was performed using STATA 18. The Kolmogorov-Smirnov test was used for analyzing continuous variables, the Chi-square test with Yates correction was applied for comparing categorical variables, and the Mann-Whitney U test was employed to compare medians.

Results A total of 96 participants completed the survey, including 33 trainees (34.4%), 28 individuals who had completed their training within the past five years (29.2%), and 35 who had completed their training more than five years prior (36.4%). The majority of respondents were from northern Italy (42 participants, 43.8%), and 48 (50%) worked in university hospitals. For most questions (8 out of 14), a significant proportion of respondents reported adherence to ESGE recommendations between 70% and 98%. However, adherence was lower for certain practices: the Hb threshold for transfusions (60%), the targeted Hb value in cardiac patients (27%), the use of proton pump inhibitors (PPIs) after an episode of variceal bleeding (29%), nasogastric tube placement for non-variceal bleeding (33%), appropriate timing of endoscopy for non-variceal bleeding (43%), and the use of proper rescue therapy for persistent variceal bleeding (45%).

Conclusions The survey demonstrated moderate-to-high adherence to most ESGE recommendations for UGIB management among young Italian gastroenterologists. Nevertheless, adherence to specific aspects of the guidelines remains suboptimal. Strategies should be developed to ensure guidelines are better implemented in routine clinical practice.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Gralnek IM. et al. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022; 54 (11): 1094-1120
• 2 Gralnek IM. et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021. Endoscopy. 2021; 53 (3): 300-332

Publication History

Article published online:
27 March 2025