Simulation in advanced endoscopy: state of the art and the next generation

Simulation is an important component of training in gastrointestinal endoscopy. Each endoscopic procedure has unique risks. Risks are more serious in advanced endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), and natural orifice translumenal endoscopic surgery (NOTES). Using simulation of advanced endoscopic procedures before performing these procedures in humans is beneficial. Because equipment and accessories change rapidly with developing technology, the use of simulators is also important for maintaining skills of practicing endoscopists as well as teaching new procedures in formal fellowships or training programs. Each simulation platform has its own menu of pros and cons. This review includes recent developments and simulation possibilities for ERCP, EUS, and NOTES with an outlook into future possibilities.