Realistic simulation of diagnostic endoscopy

Current American Society for Gastrointestinal Endoscopy and American College of Gastroenterology guidelines recommend that credentialing should occur for upper endoscopy and colonoscopy after at least 130-140 endoscopic procedures have been performed. We reviewed the currently available literature published on endoscopic simulators including the AccuTouch Immersion Simulator, the Simbionix GI Mentor II, and the Olympus colonoscopy simulator to determine their utility for training in diagnostic endoscopy, flexible sigmoidoscopy, and colonoscopy. All of the endoscopic simulators demonstrated face, construct, and expert validity when comparing novices with experts in the performance of diagnostic endoscopic procedures. For diagnostic upper endoscopy, clinical trials comparing training on an endoscopic simulator to no training demonstrated improved outcomes for performance parameters on subsequent live endoscopy cases. Data from prospective studies using simulation for teaching of flexible sigmoidoscopy skills did not demonstrate a benefit compared with bedside training, although 1 clinical trial did demonstrate reduced patient discomfort. The use of colonoscopy simulators has been associated with improved performance on subsequent live colonoscopy cases. In a large multicenter clinical trial, objective and subjective competency scores for colonoscopy were higher after 20 live cases had been performed for the simulator-trained group, and this difference persisted to 100 cases. However, a median number of 160 exams were required to achieve 90% competency in both groups. The implementation of endoscopic simulation into endoscopic training programs deserves further evaluation and consideration.