Clinical Endoscopy

Original Articles

Effectiveness of a novel ex vivo training model for gastric endoscopic submucosal dissection training: a prospective observational study conducted at a single center in Japan: Takahito Toba, Tsuyoshi Ishii, Nobuyuki Sato, Akira Nogami, Aya Hojo, Ryo Shimizu, Ai Fujimoto, Takahisa Matsuda; Clin Endosc 2025;58(1):94-101. Published online November 4, 2024; DOI: https://doi.org/10.5946/ce.2024.108

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Background
/Aims: The efficacy of endoscopic submucosal dissection (ESD) for early-stage gastric cancer is well established. However, its acquisition is challenging owing to its complexity. In Japan, G-Master is a novel ex vivo gastric ESD training model. The effectiveness of training using G-Master is unknown. This study evaluated the efficacy of gastric ESD training using the G-Master to evaluate trainees’ learning curves and performance.
Methods
Four trainees completed 30 ESD training sessions using the G-Master, and procedure time, resection area, resection completion, en-bloc resection requirement, and perforation occurrence were measured. Resection speed was the primary endpoint, and learning curves were evaluated using the Cumulative Sum (CUSUM) method.
Results
All trainees completed the resection and en-bloc resection of the lesion without any intraoperative perforations. The learning curves covered three phases: initial growth, plateau, and late growth. The transition from phase 1 to phase 2 required a median of 10 sessions. Each trainee completed 30 training sessions in approximately 4 months.
Conclusions
Gastric ESD training using the G-Master is a simple, fast, and effective method for pre-ESD training in clinical practice. It is recommended that at least 10 training sessions be conducted.

Citations

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Meaningful progress towards a high-fidelity endoscopic submucosal dissection training simulator model
Gin Hyug Lee, So Young Byun
Clinical Endoscopy.2025; 58(1): 77. CrossRef
Beyond the scope: unveiling the future of digestive endoscopy through experimental models
Federico Soria Gálvez
Revista Española de Enfermedades Digestivas.2025;[Epub] CrossRef

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The Learning Curve for Peroral Endoscopic Myotomy in Latin America: A Slide to the Right?: Michel Kahaleh, Amy Tyberg, Supriya Suresh, Arnon Lambroza, Fernando Rodriguez Casas, Mario Rey, Jose Nieto, Guadalupe Ma Martínez, Felipe Zamarripa, Vitor Arantes, Maria G Porfilio, Monica Gaidhane, Pietro Familiari, Juan Carlos Carames, Romulo Vargas-Rubio, Raul Canadas, Albis Hani, Guillermo Munoz, Bismarck Castillo, Eduardo T Moura, Farias F Galileu, Hannah P Lukashok, Carlos Robles-Medranda, Eduardo G de Moura; Clin Endosc 2021;54(5):701-705. Published online June 3, 2021; DOI: https://doi.org/10.5946/ce.2020.290

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Background
/Aims: Peroral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagas disease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEM in Latin America.
Methods
Patients undergoing POEM in Latin America with a single operator were included from a prospective registry over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve.
Results
A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 had Chagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technical success was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%) and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), and leakage (4 patients).
The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressively decreased, with the last 10 procedures under 50 min approaching a plateau (p-value <0.01).
Conclusions
Mastering POEM in Latin America requires approximately 61 procedures for both POEM efficiency and to accomplish the procedure within 97 minutes.

Citations

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Miotomía endoscópica por vía oral (POEM) como tratamiento para la acalasia pediátrica: estudio multicéntrico y primeros resultados
Carlos Leganés Villanueva, Eduardo Albéniz Arbizu, Ilaria Goruppi, Nuria Brun Lozano, Federica Bianchi, Alberto Pérez Martínez, Sheyla Montori Pina, Ada Yessenia Molina Caballero, Marianette Murzi, Federico Betroletti, Fermin Estremera, Susana Boronat Gue
Gastroenterología y Hepatología.2025; 48(4): 502262. CrossRef
Peroral endoscopic myotomy (POEM) as a treatment for pediatric achalasia: Multicenter study and first results
Carlos Leganés Villanueva, Eduardo Albéniz Arbizu, Ilaria Goruppi, Nuria Brun Lozano, Federica Bianchi, Alberto Pérez Martínez, Sheyla Montori Pina, Ada Yessenia Molina Caballero, Marianette Murzi, Federico Betroletti, Fermin Estremera, Susana Boronat Gue
Gastroenterología y Hepatología (English Edition).2025; 48(4): 502262. CrossRef
Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part I): European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
Enrique Rodríguez de Santiago, David J. Tate, João Santos-Antunes, Sandra Nagl, Zuzana Vacková, Marcel Tantau, Isis K. Araujo, Eduardo Guimarães Hourneaux de Moura, Pietro Familiari, Helmut Messmann, Alanna Ebigbo, Paul Fockens, Raf Bisschops, Henriette H
Endoscopy.2025; 57(07): 778. CrossRef
Experiencia en miotomía endoscópica peroral en un centro de Bogotá, Colombia, entre 2018 y 2022
Tatiana P Barragan Briceño, Paola Stephany Gonzalez Ausique, Carlos Fernando Fuentes Díaz, Jesús Antonio Rodríguez Fajardo, Maria Camila Gomez Ayala
Revista colombiana de Gastroenterología.2024; 39(2): 146. CrossRef
Learning curve for esophageal peroral endoscopic myotomy: a systematic review and meta-analysis
Srinivas R. Puli, Mihir S. Wagh, David Forcione, Harishankar Gopakumar
Endoscopy.2023; 55(04): 355. CrossRef
Diagnosis and Management of Achalasia: Updates of the Last Two Years
Amir Mari, Fadi Abu Baker, Rinaldo Pellicano, Tawfik Khoury
Journal of Clinical Medicine.2021; 10(16): 3607. CrossRef
Issues to be Considered for Learning Curve for Peroral Endoscopic Myotomy
Hironari Shiwaku, Haruhiro Inoue
Clinical Endoscopy.2021; 54(5): 625. CrossRef

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Three-Dimensional Flexible Endoscopy Can Facilitate Efficient and Reliable Endoscopic Hand Suturing: An ex-vivo Study: Jun Omori, Osamu Goto, Kazutoshi Higuchi, Takamitsu Umeda, Naohiko Akimoto, Masahiro Suzuki, Kumiko Kirita, Eriko Koizumi, Hiroto Noda, Teppei Akimoto, Mitsuru Kaise, Katsuhiko Iwakiri; Clin Endosc 2020;53(3):334-338. Published online April 24, 2020; DOI: https://doi.org/10.5946/ce.2019.207

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Background
/Aims: Three-dimensional (3D) flexible endoscopy, a new imaging modality that provides a stereoscopic view, can facilitate endoscopic hand suturing (EHS), a novel intraluminal suturing technique. This ex-vivo pilot study evaluated the usefulness of 3D endoscopy in EHS.
Methods
Four endoscopists (two certified, two non-certified) performed EHS in six sessions on a soft resin pad. Each session involved five stitches, under alternating 3D and two-dimensional (2D) conditions. Suturing time (sec/session), changes in suturing time, and accuracy of suturing were compared between 2D and 3D conditions.
Results
The mean suturing time was shorter in 3D than in 2D (9.8±3.4 min/session vs. 11.2±5.1 min/session) conditions and EHS was completed faster in 3D conditions, particularly by non-certified endoscopists. The suturing speed increased as the 3D sessions progressed. Error rates (failure to grasp the needle, failure to thread the needle, and puncture retrial) in the 3D condition were lower than those in the 2D condition, whereas there was no apparent difference in deviation distance.
Conclusions
3D endoscopy may contribute to increasing the speed and accuracy of EHS in a short time period. Stereoscopic viewing during 3D endoscopy may help in efficient skill acquisition for EHS, particularly among novice endoscopists.

Citations

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Future Directions for Robotic Endoscopy–Artificial Intelligence (AI), Three-Dimensional (3D) Imaging, and Natural Orifice Transluminal Endoscopic Surgery (NOTES)
Cem Simsek, Hung Leng Kaan, Hiroyuki Aihara
Techniques and Innovations in Gastrointestinal Endoscopy.2023; 25(1): 95. CrossRef
A three-dimensional measurement method for binocular endoscopes based on deep learning
Hao Yu, Changjiang Zhou, Wei Zhang, Liqiang Wang, Qing Yang, Bo Yuan
Frontiers of Information Technology & Electronic Engineering.2022; 23(4): 653. CrossRef

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Learning Curve of Capsule Endoscopy: Korean Gut Image Study Group, Yun Jeong Lim, Young Sung Joo, Dae Young Jung, Byong Duk Ye, Ji Hyun Kim, Jae Hee Cheon, Seong Eun Kim, Jae Hyuk Do, Byung Ik Jang, Jeong Seop Moon, Jin Oh Kim, Hoon Jae Chun, Myung-Gyu Choi; Clin Endosc 2013;46(6):633-636. Published online November 19, 2013; DOI: https://doi.org/10.5946/ce.2013.46.6.633

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Background/Aims

Capsule endoscopy (CE) has become an important tool for the diagnosis of small bowel disease. Although CE does not require the skill of endoscope insertion, the images should be interpreted by a person with experience in assessing images of the gastrointestinal mucosa. This investigation aimed to document the number of cases needed by trainees to gain the necessary experience for CE competency.

Methods

Fifteen cases were distributed to 12 trainees with no previous experience of CE during their gastroenterology training as clinical fellows. Twelve trainees and an expert were asked to read CE images from one patient each week for 15 weeks. The diagnosis was reported using five categories (no abnormalities detected, small bowel erosion or ulcer, small bowel tumor, Crohn disease, and active small bowel bleeding with no identifiable source). We then examined, using the κ coefficient, how the degree of mean agreements between the trainees and the expert changed as the training progressed each week.

Results

The agreement rate of CE diagnosis increased as the frequencies of interpretation increased. Most of the mean κ coefficients were >0.60 and >0.80 after week 9 and 11, respectively.

Conclusions

Experience with approximately 10 cases of CE is appropriate for trainees to attain CE competency.

Citations

Citations to this article as recorded by

Assessing the Impact of a Structured Capsule Endoscopy Training Program Using a New Validated Assessment Tool
Tiago Lima Capela, João Carlos Gonçalves, Ana Isabel Ferreira, Vítor Macedo Silva, Cláudia Macedo, Cátia Arieira, Sofia Xavier, Tiago Cúrdia Gonçalves, Pedro Boal Carvalho, Francisca Dias de Castro, Joana Magalhães, Bruno Rosa, Maria João Moreira, José Co
Journal of Gastroenterology and Hepatology.2025; 40(2): 491. CrossRef
Road map to small bowel endoscopy quality indicators
Mohamed G. Shiha, David S. Sanders, Reena Sidhu
Current Opinion in Gastroenterology.2024; 40(3): 183. CrossRef
More than 20 procedures are necessary to learn small bowel capsule endoscopy: Learning curve pilot study of 535 trainee cases
Anders Bo Nielsen, Michael Dam Jensen, Jacob Broder Brodersen, Jens Kjeldsen, Christian B. Laursen, Lars Konge, Stig Borbjerg Laursen
Endoscopy International Open.2024; 12(05): E697. CrossRef
Pediatric Web‐based Video Capsule Endoscopy Curriculum
Uma Padhye Phatak, Corey Scherer, Nan Du, Joel A. Friedlander
JPGN Reports.2022;[Epub] CrossRef
Colon capsule endoscopy in colorectal cancer screening: a systematic review
Fanny E. R. Vuik, Stella A. V. Nieuwenburg, Sarah Moen, Cristiano Spada, Carlo Senore, Cesare Hassan, Marco Pennazio, Emanuele Rondonotti, Silvia Pecere, Ernst J. Kuipers, Manon C. W. Spaander
Endoscopy.2021; 53(08): 815. CrossRef
Training, Reading, and Reporting for Small Bowel Video Capsule Endoscopy
Ariosto Hernandez-Lara, Elizabeth Rajan
Gastrointestinal Endoscopy Clinics of North America.2021; 31(2): 237. CrossRef
The impact of reader fatigue on the accuracy of capsule endoscopy interpretation
Sabina Beg, Tim Card, Reena Sidhu, Ewa Wronska, Krish Ragunath, Hey-Long Ching, Anastasios Koulaouzidis, Diana Yung, Simon Panter, Mark Mcalindon, Matthew Johnson, Arun Kurup, Anthony Shonde, Miliedis San-Juan Acosta, Stefano Sansone, Ebby Simmon, Victori
Digestive and Liver Disease.2021; 53(8): 1028. CrossRef
Prospective multicenter study to evaluate capsule endoscopy competency using a validated assessment tool
Elizabeth Rajan, Manuel Martinez, Emmanuel Gorospe, Badr Al Bawardy, Akira Dobashi, Kristin C. Mara, Stephanie L. Hansel, David H. Bruining, Joseph A. Murray, Cadman L. Leggett, Vandana Nehra, Prasad G. Iyer, Shabana F. Pasha, Jonathan A. Leighton, Arthur
Gastrointestinal Endoscopy.2020; 91(5): 1140. CrossRef
Training in video capsule endoscopy: Current status and unmet needs
Apostolos Koffas, Faidon-Marios Laskaratos, Owen Epstein
World Journal of Gastrointestinal Endoscopy.2019; 11(6): 395. CrossRef
Optimising the performance and interpretation of small bowel capsule endoscopy
Sabina Beg, Adolfo Parra-Blanco, Krish Ragunath
Frontline Gastroenterology.2018; 9(4): 300. CrossRef
Influencia de la experiencia acumulada del explorador en el valor predictivo negativo de la cápsula endoscópica
Benito Velayos Jiménez, Noelia Alcaide Suárez, Guillermo González Redondo, Luis Fernández Salazar, Rocío Aller de la Fuente, Lourdes del Olmo Martínez, Lourdes Ruiz Rebollo, José Manuel González Hernández
Gastroenterología y Hepatología.2017; 40(1): 10. CrossRef
Impact of the endoscopist's experience on the negative predictive value of capsule endoscopy
Benito Velayos Jiménez, Noelia Alcaide Suárez, Guillermo González Redondo, Luis Fernández Salazar, Rocío Aller de la Fuente, Lourdes del Olmo Martínez, Lourdes Ruiz Rebollo, José Manuel González Hernández
Gastroenterología y Hepatología (English Edition).2017; 40(1): 10. CrossRef
Colon capsule endoscopy: toward the future
Naoki Muguruma, Kumiko Tanaka, Satoshi Teramae, Tetsuji Takayama
Clinical Journal of Gastroenterology.2017; 10(1): 1. CrossRef
NASPGHAN Capsule Endoscopy Clinical Report
Joel A. Friedlander, Quin Y. Liu, Benjamin Sahn, Koorosh Kooros, Catharine M. Walsh, Robert E. Kramer, Jenifer R. Lightdale, Julie Khlevner, Mark McOmber, Jacob Kurowski, Matthew J. Giefer, Harpreet Pall, David M. Troendle, Elizabeth C. Utterson, Herbert
Journal of Pediatric Gastroenterology and Nutrition.2017; 64(3): 485. CrossRef
A 13-year time trend analysis of 3724 small bowel video capsule endoscopies and a forecast model during the financial crisis in Greece
Konstantinos Triantafyllou, Paraskevas Gkolfakis, Nikos Viazis, Panagiotis Tsibouris, Athanasios Tsigaridas, Periklis Apostolopoulos, John Anastasiou, Eleni Hounda, Ioannis Skianis, Konstantina Katopodi, Xhoela Ndini, George Alexandrakis, Demetrios G. Kar
European Journal of Gastroenterology & Hepatology.2017; 29(2): 185. CrossRef
Recommandations du CDU–HGE, du CNU d’HGE et de la SFED sur la formation en endoscopie digestive
M. Robaszkiewicz, M. Barthet, P. Bulois, S. Chaussade, E. Coron, X. Dray, R. Laugier, T. Lecomte, D. Moussata, T. Ponchon, F. Prat, J. -M. Reimund, J. -C. Saurin, D. Sautereau, M. Dapoigny, C. Silvain
Acta Endoscopica.2016; 46(5): 282. CrossRef
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