Clinical Endoscopy

Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea: Hyundam Gu, Suyoung Lee, Sol Kim, Hye-Lim Jang, Da-Woon Choi, Kyu Seok Kim, Yu Ri Shin, Dae Young Cheung, Bo-In Lee, Jin Il Kim, Han Hee Lee; Clin Endosc 2024;57(6):790-797. Published online September 23, 2024; DOI: https://doi.org/10.5946/ce.2024.110

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Colonic stenting plays a vital role in the management of acute malignant colonic obstruction. The increasing use of self-expandable metal stents (SEMS) and the diverse challenges posed by colonic obstruction at various locations underscore the importance of effective training for colonic stent placement.
Methods
All the components of the simulator were manufactured using silicone molding techniques in conjunction with three-dimensional (3D) printing. 3D images sourced from computed tomography scans and colonoscopy images were converted into a stereolithography format. Acrylonitrile butadiene styrene copolymers have been used in fused deposition modeling to produce moldings.
Results
The simulator replicated the large intestine from the rectum to the cecum, mimicking the texture and shape of the human colon. It enables training for colonoscopy insertion, cecum intubation, loop reduction, and stenting within stenotic areas. Interchangeable stenotic modules for four sites (rectum, sigmoid colon, descending colon, and ascending colon) were easily assembled for training. These modules integrate tumor contours and blood vessel structures with a translucent center, allowing real-time visualization during stenting. Successful and repeatable demonstrations of stent insertion and expansion using the reusable SEMS were consistently achieved.
Conclusions
This innovative simulator offers a secure colonic stenting practice across various locations, potentially enhancing clinical outcomes by improving operator proficiency during actual procedures.

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Usefulness of a new polyvinyl alcohol hydrogel (PVA-H)-based simulator for endoscopic submucosal dissection training: a pilot study: Dong Seok Lee, Gin Hyug Lee, Sang Gyun Kim, Kook Lae Lee, Ji Won Kim, Ji Bong Jeong, Yong Jin Jung, Hyoun Woo Kang; Clin Endosc 2023;56(5):604-612. Published online May 18, 2023; DOI: https://doi.org/10.5946/ce.2022.163

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: We developed a new endoscopic submucosal dissection (ESD) simulator and evaluated its efficacy and realism for use training endoscopists.
Methods
An ESD simulator was constructed using polyvinyl alcohol hydrogel sheets and compared to a previous ESD simulator. Between March 1, 2020, and December 30, 2021, eight expert endoscopists from three different centers analyzed the procedure-related factors of the simulator. Five trainees performed gastric ESD exercises under the guidance of these experts.
Results
Although the two ESD simulators provided overall favorable outcomes in terms of ESD-related factors, the new simulator had several benefits, including better marking of the target lesion’s limits (p<0.001) and overall handling (p<0.001). Trainees tested the usefulness of the new ESD simulator. The complete resection rate improved after 3 ESD training sessions (9 procedures), and the perforation rate decreased after 4 sessions (12 procedures).
Conclusions
We have developed a new ESD simulator that can help beginners achieve a high level of technical experience before performing real-time ESD procedures in patients.

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The Current Landscape of Endoscopic Submucosal Training in the United States
Mike T. Wei, Shai Friedland, Joo Ha Hwang
Current Gastroenterology Reports.2025; 27(1): 1. CrossRef
There is no royal road: a shortcut for endoscopic submucosal dissection training
Seong Woo Jeon
Clinical Endoscopy.2023; 56(5): 590. CrossRef

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Validation of a Novel Endoscopic Retrograde Cholangiopancreatography Cannulation Simulator: Pichamol Jirapinyo, Andrew C. Thompson, Hiroyuki Aihara, Marvin Ryou, Christopher C. Thompson; Clin Endosc 2020;53(3):346-354. Published online February 17, 2020; DOI: https://doi.org/10.5946/ce.2019.105

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) requires a unique skill set. Currently, there is no objective methodology to assess and train a professional to perform ERCP. This study aimed to develop and validate a novel ERCP simulator.
Methods
The simulator consists of papillae presenting different anatomy and positioned in varied locations. Deep cannulation of the pancreatic duct, followed by the bile duct, was performed. The time allotted was 5 minutes. The content validity indexes (CVIs) for realism, relevance, and representativeness were calculated. Correlation between ERCP experience and simulator score was determined.
Results
Twenty-three participants completed the simulation. The CVIs for realism were orientation of duodenoscope to papilla (1.00), angulation of papillotome to achieve cannulation (0.71), and haptic feedback during cannulation (0.80). The CVIs for relevance were use of elevator (1.00), wheels to achieve en face orientation (1.00), and papillotome for selective cannulation (1.00). Regarding CVI for representativeness, the results were as follows: basic cannulation (0.83), papilla locations (0.83), and papilla anatomies (0.80). The novice, intermediate, and experienced groups scored 6.7±8.7, 30.0±16.3, and 74.4±43.9, respectively (p<0.0001). There was a strong correlation between the ERCP experience level and the individual’s simulator score (Pearson value of 0.77, R2 of 0.60).
Conclusions
This simulator appears to be realistic, relevant, and representative of ERCP cannulation techniques. Additionally, it is effective at objectively assessing basic ERCP skills by differentiating scores based on clinical experience.

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Morfología de la papila de Vater como factor que influye en el éxito en canulación durante el entrenamiento del Residente en Endoscopia Avanzada. Estudio clínico prospectivo
D.E. Benavides-Salgado, R.A. Jiménez-Castillo, J.E. Cuéllar-Monterrubio, J.O. Jáquez-Quintana, A. Garza-Galindo, C. Cortes-Hernández, H.J. Maldonado-Garza, D. García-Compeán, J.A. González-González
Revista de Gastroenterología de México.2024; 89(2): 237. CrossRef
Papilla of Vater morphology as an influencing factor in successful cannulation during resident training in advanced endoscopy. A prospective clinical study
D.E. Benavides-Salgado, R.A. Jiménez-Castillo, J.E. Cuéllar-Monterrubio, J.O. Jáquez-Quintana, A. Garza-Galindo, C. Cortes-Hernández, H.J. Maldonado-Garza, D. García-Compeán, J.A. González-González
Revista de Gastroenterología de México (English Edition).2024; 89(2): 237. CrossRef
Anatomical endoscopic retrograde cholangiopancreatography simulator using moulded meshed silicone: A novel simulator pilot study
Alen Maximillian Brodaric, Ngar Lok Joshua Wong, Jessica Falon, Jean Wong, Kai Cheng, Sarah Whereat, David Storey
ANZ Journal of Surgery.2023; 93(7-8): 1817. CrossRef
The use of simulators to acquire ERCP skills: a systematic review
Konstantinos Georgiou, Kiril T. Atliev, Ninos Oussi, Nikola Boyanov, Gabriel Sandblom, Lars Enochsson
Annals of Medicine & Surgery.2023; 85(6): 2924. CrossRef
There is no royal road: a shortcut for endoscopic submucosal dissection training
Seong Woo Jeon
Clinical Endoscopy.2023; 56(5): 590. CrossRef
Validity of a virtual reality endoscopic retrograde cholangiopancreatography simulator: can it distinguish experts from novices?
Konstantinos Georgiou, Nikola Boyanov, Pantelis Antonakis, Dimitrios Thanasas, Gabriel Sandblom, Lars Enochsson
Frontiers in Surgery.2023;[Epub] CrossRef
Training in endoscopic retrograde cholangio-pancreatography: a critical assessment of the broad scenario of training programs and models
Camilla Gallo, Ivo Boškoski, Maria Valeria Matteo, Beatrice Orlandini, Guido Costamagna
Expert Review of Gastroenterology & Hepatology.2021; 15(6): 675. CrossRef

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