Training endoscopists to recognize the stigmata of hemorrhage in bleeding ulcers

Correctly assessing the stigmata of recent hemorrhage is critical to providing appropriate endoscopic and medical management in patients with bleeding ulcers. However, the task of training endoscopists to recognize stigmata in ulcers is particularly difficult, for a number of reasons. First, the source of bleeding must be located, and this may be difficult when blood is present or the patient is unstable; second, the ulcer base must be completely examined, sometimes requiring target irrigation or manipulation of the surrounding folds with a device; third, the presence or absence of stigmata must be recognized; and finally, the stigma must be accurately identified. A major problem is that even expert endoscopists and investigators in the field of hemostasis have not achieved a consensus on definitions of stigmata. Nonetheless, the available data suggest that endoscopists can be trained to identify stigmata with reasonable consistency.