Endoscopic Training Research Articles

Entrenamiento microneuroquirúrgico en el espécimen anatómico. Propuesta de un plan estructurado de disección endoscópica y microquirúrgica basicraneal durante la residencia

Background and objectiveThe development of a high level of competence and technical proficiency is one of the main objectives of any neurosurgical training program. Due to many factors, this progressive skill development can be complex during the residency. Despite its high cost and infrastructure requirements, there is renewed interest regarding the role of anatomy labs. The study and dissection of the human cadaver has been the environment where many surgeons have developed the necessary skills for microneurosurgery. We propose a structured endoscopic and microsurgical training dissection program to enable residents to maximize the benefits of their training in the lab. Material and methodsDuring the months of September, October and November 2021, a stay was done at the Microneurosurgery and Skull Base Laboratory of the Miguel Hernández University of Alicante. A total of 2 specimens were used. The first specimen underwent a first endoscopic endonasal dissection phase. After completing the endonasal part, a set of incisions were made to perform the transcranial part. In the second specimen, the transcranial part was performed first, leaving the endonasal endoscopic work for the last phase. ResultsThe results of the dissection program are presented. During the endonasal endoscopic phase, the transsphenoidal approach to the sella was simulated while focusing on the extended approaches in the sagittal plane. During the transcranial phase, right and left anterolateral approaches, a left anterior transcallosal interhemispheric approach, a left transcondylar posterolateral approach and a combined right lateral approach were performed. ConclusionsThe structured dissection of the specimen allowed both endonasal endoscopic and transcranial microsurgical training in the same specimen. This design facilitated the realization of the core skull base approaches in the same specimen. According to our initial experience, we believe that developing common dissection programs is a powerful tool to maximize the results of our residents’ laboratory training.

Endoscopic Sleeve Gastroplasty: A Practice Pattern Survey.

Obesity is a complex, chronic disease that is strongly associated with complications which cost the US healthcare system billions of dollars per year. Endoscopic sleeve gastroplasty (ESG) has emerged as a safe and effective procedure for treatment of obesity, but without practice guidelines there are likely to be variations practice. We sought to describe current practice patterns amongst endoscopists who perform ESG to help define areas of focus for future research and guideline development. We conducted an anonymous cross-sectional survey to examine practice patterns related to ESG. The survey was organized in 5 sections: Endoscopic Practice, Training, and Resources; Pre-ESG Evaluation and Payment Model; Perioperative/Operative Period; Post-operative Period; and Endobariatric Practice Other Than ESG. A variety of exclusion criteria were reported by physicians performing ESG. Most respondents (n = 21/32, 65.6%) would not perform ESG for BMI under 27, and 40.6% (n = 13/32) would not perform ESG on patients with BMI over 50. The majority of respondents (74.2%, n = 23/31) reported ESG was not covered in their region, and most reported patients covered residual costs (67.7%, n = 21/31). We found significant variability with respect to practice setting, exclusion criteria, pre-procedural evaluation, and medication use. Without guidelines for the selection of patients or standards for pre- and post-ESG care, substantial barriers to coverage will remain, and ESG will remain limited to those who can meet out-of-pocket costs. Larger studies are needed to confirm our findings, and future research should be focused on establishing patient selection criteria and standards in practices to provide guidance for endobariatric programs.

Development of a novel colorectal endoscopic submucosal dissection training model.

Colorectal endoscopic submucosal dissection (ESD) requires technically advanced endoscopic skill. To improve endoscopic skills, animals or their extracted digestive tracts are used for ESD training [1] [2] [3], which raises several issues regarding ethics, cost, and infection.

A novel approach to improving colonoscopy learning efficiency through a colonoscope roaming system: randomized controlled trial.

Colonoscopy is indispensable in the diagnosis and treatment of lower digestive tract (LDT) diseases. Skilled colonoscopists are in great demand, but it takes considerable time for beginners to become experts. In addition, patients may refuse to permit primary learners to practise colonoscopy on them. Thus, improving the instructional programmes and models for primary learners is a key issue in endoscopy training. Convenience and a self-paced, learner-centred approach make e-learning an excellent instructional prospect. Therefore, we created the Colonoscope Roaming System (CRS) to assist in colonoscopy teaching procedures. We aimed to develop the e-learning software, test it with beginner colonoscopists and evaluate its effectiveness via subjective and objective methods. Through a randomized controlled trial, participants were randomly allocated to an e-learning group (EG) or a control group (CG) after a pretest evaluation. The CG learned through the traditional colonoscopy teaching mode, while the EG used CRS in addition to the traditional teaching mode. Subsequent to the training, the participants completed a posttest and colonoscopy examination. The EG also completed a satisfaction questionnaire. Of the 84 participants, 81 (96%) finished the colonoscopy learning and evaluation modules of the CRS. No conspicuous differences in the pretest scores were found between the EG and CG (p>0.05). Two months later, the posttest scores for the EG were higher than those of the CG (p<0.001), and the EG had better performance on the colonoscopy examination (p<0.01). Overall, 86.25% of questions raised in Q1-Q20 were satisfied with the CRS and considered it successful. The use of CRS may be an effective approach to educate beginner colonoscopists to attain skills.

Curriculum for training in endoscopic mucosal resection in the colon: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

Endoscopic mucosal resection (EMR) is the standard of care for the complete removal of large (≥ 10 mm) nonpedunculated colorectal polyps (LNPCPs). Increased detection of LNPCPs owing to screening colonoscopy, plus high observed rates of incomplete resection and need for surgery call for a standardized approach to training in EMR. 1 : Trainees in EMR should have achieved basic competence in diagnostic colonoscopy, < 10-mm polypectomy, pedunculated polypectomy, and common methods of gastrointestinal endoscopic hemostasis. The role of formal training courses is emphasized. Training may then commence in vivo under the direct supervision of a trainer. 2 : Endoscopy units training endoscopists in EMR should have specific processes in place to support and facilitate training. 3: A trained EMR practitioner should have mastered theoretical knowledge including how to assess an LNPCP for risk of submucosal invasion, how to interpret the potential difficulty of a particular EMR procedure, how to decide whether to remove a particular LNPCP en bloc or piecemeal, whether the risks of electrosurgical energy can be avoided for a particular LNPCP, the different devices required for EMR, management of adverse events, and interpretation of reports provided by histopathologists. 4: Trained EMR practitioners should be familiar with the patient consent process for EMR. 5: The development of endoscopic non-technical skills (ENTS) and team interaction are important for trainees in EMR. 6: Differences in recommended technique exist between EMR performed with and without electrosurgical energy. Common to both is a standardized technique based upon dynamic injection, controlled and precise snare placement, safety checks prior to the application of tissue transection (cold snare) or electrosurgical energy (hot snare), and interpretation of the post-EMR resection defect. 7: A trained EMR practitioner must be able to manage adverse events associated with EMR including intraprocedural bleeding and perforation, and post-procedural bleeding. Delayed perforation should be avoided by correct interpretation of the post-EMR defect and treatment of deep mural injury. 8: A trained EMR practitioner must be able to communicate EMR procedural findings to patients and provide them with a plan in case of adverse events after discharge and a follow-up plan. 9: A trained EMR practitioner must be able to detect and interrogate a post-endoscopic resection scar for residual or recurrent adenoma and apply treatment if necessary. 10: Prior to independent practice, a minimum of 30 EMR procedures should be performed, culminating in a trainer-guided assessment of competency using a validated assessment tool, taking account of procedural difficulty (e. g. using the SMSA polyp score). 11: Trained practitioners should log their key performance indicators (KPIs) of polypectomy during independent practice. A guide for target KPIs is provided in this document.

Comparison of Texture and Color Enhancement Imaging with White Light Imaging in 52 Patients with Short-Segment Barrett's Esophagus.

BACKGROUND Texture and color enhancement imaging (TXI), a new type of image-enhanced endoscopy, may improve the detection of gastrointestinal lesions. Barrett's esophagus (BE) requires an accurate diagnosis since it may undergo neoplastic transformation. We aimed to evaluate the usefulness of TXI compared with white light imaging (WLI) in BE. MATERIAL AND METHODS In this prospective study at a single hospital from February 2021 to February 2022, we enrolled 52 consecutive patients with BE. Endoscopic images of BE using WLI, TXI mode 1 (TXI-1), TXI mode 2 (TXI-2), and narrow-band imaging (NBI) were compared by 10 endoscopists (5 experts and 5 trainees). Endoscopists scored visibility for the images as follows: 5 (improved), 4 (somewhat improved), 3 (equivalent), 2 (somewhat decreased), and 1 (decreased). Total visibility scores for all 10 endoscopists, and subgroups composed of the 5 expert endoscopists and the 5 trainee endoscopists, were evaluated. Main-group (10 endoscopists) scores of ≥40, 21-39, and ≤20, and subgroup (5 endoscopists) scores of ≥20, 11-19, and ≤10, were considered "improved", "equivalent", and "decreased", respectively. Inter-rater reliability (intra-class correlation coefficient [ICC]) was calculated and images were objectively assessed based on L*a*b* color values and color differences (ΔE*). RESULTS All 52 cases were diagnosed as short-segment BE (SSBE). TXI-1/TXI-2 improved visibility compared with WLI was: 78.8%/32.7% for all endoscopists; 82.7%/40.4% for trainees; and 76.9%/34.6% for experts. NBI did not improve visibility. The ICC for TXI-1 and TXI-2 compared with WLI was "excellent" for all endoscopists. The ΔE* between esophageal and Barrett's mucosae, and between Barrett's and gastric mucosae, was higher for TXI-1 than for WLI (P<0.01, P<0.05, respectively). CONCLUSIONS TXI, especially TXI-1, improves the endoscopic diagnosis of SSBE compared with WLI, regardless of the endoscopist's skill.

Exvivo nonbiomaterial gel-based model for endoscopic training.

Video 1Use of artificial model for endoscopic training.

Usefulness of a new polyvinyl alcohol hydrogel (PVA-H)-based simulator for endoscopic submucosal dissection training: a pilot study.

We developed a new endoscopic submucosal dissection (ESD) simulator and evaluated its efficacy and realism for use training endoscopists. 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. 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). 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.

The effect of short-term training about depth predicting score on the diagnostic ability of invasion depth for differentiated early gastric Cancer among non-expert endoscopists

BackgroundThe depth-predicting score (DPS) was proposed based on conventional white-light imaging (C-WLI) endoscopic features of early gastric cancer (EGC) to determine the invasion depth of the neoplasm. However, the effect of DPS on training endoscopists remains unclear. Therefore, we aimed to investigate the effect of short-term DPS training on improving the diagnostic ability of EGC invasion depth and compare the training effect among non-expert endoscopists at different levels.MethodsIn the training session, the definitions and scoring rules of DPS were instructed, and classic C-WLI endoscopic example graphics were exhibited to the participants. Another C-WLI endoscopic images of 88 cases of histologically proven differentiated EGC were selected as an independent test dataset for evaluating the training effect. Each participant was tested, and the diagnostic accuracy rate of invasion depth was calculated differently one week before the training and after the completion of training.ResultsA total of 16 participants were enrolled and completed the training. Participants were divided into a trainee group and a junior endoscopist group according to the total number of C-WLI endoscopies performed. The total number of C-WLI endoscopies performed showed a significant difference between the trainee group and junior endoscopist group (350 vs. 2500, P = 0.001). No significant difference between the trainee group and junior endoscopist group was observed for pre-training accuracy. The overall diagnostic accuracy of invasion depth was improved significantly after completing DPS training compared with before (68.75 ± 5.71% vs. 61.58 ± 9.61%, P = 0.009). In the subgroup analysis, the post-training accuracy was higher than the pre-training accuracy, but significant improvement was observed only in the trainee group (61.65 ± 7.33% vs. 68.32 ± 5.71%, P = 0.034). In addition, no significant difference in post-training accuracy between the two groups was observed.ConclusionShort-term DPS training can improve the diagnostic ability of the invasion depth of EGC and homogenize the diagnostic ability of non-expert endoscopists at different levels. The depth-predicting score was convenient and effective for endoscopist training.

Difficult colorectal polypectomy: Technical tips and recent advances.

Colonoscopy has been shown to be an effective modality to prevent colorectal cancer (CRC) development. CRC reduction is achieved by detecting and removing adenomas, which are precursors of CRC. Most colorectal polyps are small and do not pose a significant challenge for trained and skilled endoscopists. However, up to 15% of polyps are considered "difficult", potentially causing life-threatening complications. A difficult polyp is defined as any polyp that is challenging for the endoscopist to remove owing to its size, shape, or location. Advanced polypectomy techniques and skills are required to resect difficult colorectal polyps. There were various polypectomy techniques for difficult polyps such as endoscopic mucosal resection (EMR), underwater EMR, Tip-in EMR, endoscopic submucosal dissection (ESD), or endoscopic full-thickness resection. The selection of the appropriate modality depends on the morphology and endoscopic diagnosis. Several technologies have been developed to aid endoscopists in performing safe and effective polypectomies, especially complex procedures such as ESD. These advances include video endoscopy system, equipment assisting in advanced polypectomy, and closure devices/techniques for complication management. Endoscopists should know how to use these devices and their availability in practice to enhance polypectomy performance. This review describes several useful strategies and tips for managing difficult colorectal polyps. We also propose the stepwise approach for difficult colorectal polyps.

Artificial intelligence (AI) in the management of colorectal cancer: on the horizon?

In the era of personalized medicine, an ever increasing emphasis is being placed on prognostication and prediction of surgical outcomes and treatment responses in colorectal cancer (CRC).1 Recent advances in information technology have allowed AI integration into clinical practice. Machine learning (ML) is a subfield of AI in which algorithms iteratively ‘learn’ from data to make predictions based on discerned patterns, without being explicitly programmed to do so. Deep learning (DL) is a further subfield of ML, whereby artificial neural networks (ANN) loosely modelled on the human brain structure, are exposed to large or ‘deep’ datasets, deriving predictive capacity from learned patterns in the data.2 Computer vision (CV) refers to the training of computers to read and interpret images, a field closely involved in the last half-decade with DL approaches. Within Radiomics, AI is making an impact in CRC staging.1 DL platforms have demonstrated the ability to distinguish between T2 and T3 rectal cancer on MRI with 90% accuracy,3 and to detect lymph node disease with a higher accuracy than radiologists.4 The combination of histopathological outcomes with MRI and CT imaging shows promise. It allows models to predict a complete pathological response in rectal cancer patients treated with neoadjuvant therapy and the identification of systemic therapy responders with metastatic CRC.1 Colonoscopy is an area in which AI is already being used. AI algorithms designed to aid polyp detection have been shown to increase adenoma detection rates, even amongst experienced endoscopists,5 thus providing a cost effective method of reducing CRC during population screening.6 DL models can both detect and classify polyps with high sensitivity and specificity.7 The development of AI-assisted clinical tools that can provide decision support such as future endoscopic surveillance intervals are ongoing.5 Such tools can also enhance endoscopy training through improved polyp pattern recognition identification.5 Support systems which provide evidence-based clinical decision making tools for CRC are already available. The Watson for Oncology (WFO) program developed by IBM and the Memorial Sloan Kettering Cancer Centre has been trained to follow the U.S. National Comprehensive Cancer Network guidelines.8 Treatment recommendations suggested by the WFO have shown concordance rates of 80%–90% for CRC management compared to a multidisciplinary team (MDT).8, 9 Although not designed to supplant the MDT, AI tools can become an adjunct for clinicians to increase workload time efficiency, and decrease the risk of errors.8 Though still in its infancy, the utilization of AI tools is becoming increasingly relevant within colorectal surgery, through the intraoperative use of CV10 for operative precision and training. Using laparoscopic image data from multiple rectal resections, DL models have been able to recognize the correct phase of the operation, and also act as an intra-operative guide in the identification of complex anatomical structures, such as the total mesorectal excision plane of dissection.10, 11 A recent pilot study has demonstrated the utilization of DL-based software to automate the surgical skill assessment of various steps within a laparoscopic rectal resection, paving its way for future applications in surgical training.12 Despite these exciting developments, many limitations remain. Significant financial investment and creation of regulatory and legal frameworks will be required to integrate AI into existing healthcare systems.13 Furthermore, AI is constrained by the quality and quantity of available data used to train them. As the majority of relevant studies come from only a few geographical locations, AI models are susceptible to inherent biases related to differing patient cohorts.14 AI has the potential to revolutionize the management of CRC. However, there are many challenges to be addressed before AI programs can become embedded into routine care for CRC. Open access publishing facilitated by The University of Melbourne, as part of the Wiley - The University of Melbourne agreement via the Council of Australian University Librarians. Matthew Y. K. Wei: Conceptualization; writing – original draft; writing – review and editing. Junyao Zhang: Writing – review and editing. Reuben Schmidt: Validation; writing – review and editing. Andrew S. Miller: Writing – review and editing. Justin M. C. Yeung: Supervision; validation; writing – review and editing.

WEO Newsletter.

WEO Newsletter.

Editorial introductions.

Current Opinion in Oncology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Joel GuigayJoel GuigayJoël Guigay is Professor of Medicine, Past Director of Cancer Center Antoine-Lacassagne in Nice, France, and Past President of the Head & Neck-Unicancer group. Prior to this, he was Head Physician in the Department of Head & Neck and Thoracic Medical Oncology at Gustave Roussy in Villejuif, France. Professor Guigay received his Medical Degree from Lyon University of Medicine, France, in 1984 and subsequently undertook extensive postgraduate training in Pneumology, Cancerology, Oncogenesis, and Thoracic Endoscopy. In 2001, he was appointed Professor of Medicine at the Hôpital d’Instruction des Armées Val-de-Grâce in Paris, France. He currently serves as Head of partnerships and clinical development - Early assets for the Groupe Oncologie Radiothérapie Tête et Cou (GORTEC), and as deputy director of the Hospital University Federative OncoAge. In addition, he is an active member of many national and international societies, including the American Society of Clinical Oncology (ASCO), the European Society for Medical Oncology (ESMO) as a Faculty member for Head and Neck cancers and as a member of the OncologyPro WG, as Co-Chair of the scientific committee of the Head and Neck Cancer International Group (HNCIG). His main fields of interest are head and neck and lung oncology with a focus on rare tumors, salivary gland tumors, nasopharyngeal cancers and neuroendocrine tumors. His areas of research include clinical studies with new drugs and translational research with a focus on immunotherapy. Professor Guigay coordinates several clinical trials including phase I to large randomized trials in recurrent or metastatic HNSCC such as TPExtreme trial. He currently leads also a large research program for elderly head and neck cancer patients (ELAN study). Arif HussainArif HussainArif Hussain, MD, is Professor of Medicine with Tenure in the Department of Medicine, School of Medicine, at the University of Maryland in Baltimore, USA, where he is also Professor of Biochemistry in the Department of Biological Chemistry and Professor of Pathology in the Department of Pathology. He serves as Co-Leader of the Hormone Related Cancers Program at the University of Maryland Greenebaum Comprehensive Cancer Center. Dr Hussain's clinical interest is in genitourinary cancers, and he serves as Principal Investigator on several clinical trials that focus on therapies for high risk, recurrent and metastatic prostate cancer, as well as renal cell cancer. In addition, he has a research laboratory with a translational focus, studying drug resistance and adaptive intracellular signaling pathways in treatment-sensitive and treatment-resistant prostate cancer.

Feasibility of A Multimodal Image-Assisted 3D Endoscopic Surgical Training System Using VR-HMD for Robotic-Assisted Endoscopic Total Prostatectomy

Feasibility of A Multimodal Image-Assisted 3D Endoscopic Surgical Training System Using VR-HMD for Robotic-Assisted Endoscopic Total Prostatectomy

Evaluation of a New Animal Tissue-Free Bleeding Model for Training of Endoscopic Hemostasis.

For endoscopists, knowledge of the available hemotherapeutic devices and materials as well as competence in using them is a life-saving expertise in the treatment of patients with acute gastrointestinal bleeding. These competences can be acquired in training on live animals, animal organs, or simulators. We present an animal tissue-free training model of the upper gastrointestinal tract for bleeding therapy. An artificial, animal tissue-free mucosa and submucosa with the opportunity of injection and clipping therapy were created first. Patches with this artificial mucosa and submucosa were placed into silicone and latex organs with human-like anatomy. Esophageal bleeding situations were imitated as variceal bleeding and bleeding of a reflux esophagitis in latex organs. Finally, a modular training model with human anatomy and replaceable bleeding sources was created. Evaluation of the novel model for gastroscopic training was performed in a multicentric setting with endoscopic beginners and experts. Evaluation was carried out by 38 physicians with different levels of education in endoscopy. Evaluation of the model was made with grades from one (excellent) to six (bad): suitability for endoscopic training was 1.4, relevance of the endoscopic training was 1.6, and grading for haptic and optic impression of the model was 1.7. The creation of a gastroscopic model for the training of hemostatic techniques without animal tissues was possible and multiple endoscopic bleeding skills could be trained in it. Evaluation showed good results for this new training option, which could be used in every endoscopic unit or other places without hygienic doubts.

Usefulness of texture and color enhancement imaging (TXI) in early gastric cancer found after Helicobacter pylori eradication

Early-stage gastric cancer (EGC) found after Helicobacter pylori (Hp) eradication is often difficult to diagnose using conventional white light (WL) endoscopy. We aimed to evaluate whether Texture and Color Enhancement Imaging (TXI), a new image-enhanced endoscopy enhances the EGC lesions after Hp eradication. We also compared diagnostic accuracy and lesion detection time between WL and TXI in trainee endoscopists. 58 EGC lesions after successful Hp eradication were enrolled. Using endoscopic images in WLI, TXI mode 1 (TXI1), and TXI mode 2 (TXI2), visibility of EGC was assessed by six expert endoscopists using a subjective score. Mean color differences (ΔE) of four matched adjacent and intra-tumoral points were examined. Using randomly allocated images, diagnostic accuracy and lesion detection time were evaluated in three trainee endoscopists. Visibility score was unchanged (Score 0) in 20.7% (12/58) and 45.6% (26/57), slightly improved (Score 1) in 60.3% (35/58) and 52.6% (30/57), obviously improved (Score 2) in 45.6% (26/58) and 1.8% (1/57), in TXI1 and TXI2 compared to WL, respectively. Mean ΔE ± SEM in TXI1 (22.90 ± 0.96), and TXI2 (15.32 ± 0.71) were higher than that in WL (1.88 ± 0.26, both P < 0.0001). TXI1 presented higher diagnostic accuracy compared to WL, in two of three trainees (94.8% vs. 74.1%, 100% vs. 89.7%, P = 0.003; < 0.005, respectively). Lesion detection time was shorter in TXI1 in two of three trainees (P = 0.006, 0.004, respectively) compared to WL. TXI improves visibility of EGC after Hp eradication that may contribute to correct diagnosis.

Reducing the learning curve of interlaminar full-endoscopic discectomy: mushroom model-simulation training.

To describe a cheap simulation model used to reduce the learning curve of the interlaminar full-endoscopic discectomy in a pilot study. The steep and difficult learning curve remain one of the main obstacles against the widespread diffusion of interlaminar full endoscopic lumbar discectomy (ILFED). One solution to overcome this learning curve is training with deliberate practice. As realistic models are relatively expensive and cadaver workshops not readily available, we developed a simple and cheap model to train the key steps of the procedure. A simple and cheap model were designed. It consists of a king oyster mushroom stalk, a glove finger, a sponge and cotton wool. In order to fix the model to the table and to simulate the level of the patient's skin whereupon the hand of the surgeon relies, a wooden holding device was also used. As the purpose of this pilot study was to evaluate the model as a stimulator, it was tested during an advanced endoscopic training course. A step-by-step learning method with key steps was used by participants attending an advanced ILFED training on expensive realistic models. The model was considered as comparable and enough realistic to train key steps in order to reduce the learning curve and training costs. We present an affordable, simple and reproducible training model, which allows for deliberate practice of the key steps of the ILFED procedure. The model may be used by surgeons starting with spinal endoscopy.

Prospective Analysis of Versatility and User Satisfaction with a Novel Single-Use Cystoscope with Working Channel

Introduction: In the present study, a prospective systematic assessment of the clinical utility of the Ambu^® aScopeTM 4 Cysto Reverse Deflection with regard to image quality, maneuverability, and navigation in an outpatient and inpatient setting was performed. Materials and Methods: A prospective multicenter study was performed for evaluation of the instrument during routine cystoscopy. We evaluated the clinical performance of the instruments using a standardized user questionnaire in different categories including image quality, treatment success, imaging of all areas of the urinary bladder, quality of navigation, flexibility of the endoscope, and satisfaction with the device. Statistical analyses were performed by SPSS using the Kruskal-Wallis and Wilcoxon-Mann-Whitney tests. A p value of p ≤ 0.05 was defined as statistically significant. Results: A total of 200 cystoscopies were performed, and the questionnaire response rate was 100%. The image quality was rated as very good in 65.5% (n = 131), good in 30.5% (n = 61), and neutral in 4% (n = 8) of cases. The criteria for poor or very poor were not mentioned. The characteristic “treatment success based on image quality” was also evaluated as very good in 49% (n = 98) and good in 50.5% (n = 101). The analysis revealed a very good or good overall impression of the examiners in all cases. Replacement of the cystoscope was not necessary during any of the examinations. However, in 3 cases, technical difficulties were documented. Further analysis of the data showed that physicians with less professional experience rated the visualization of the urinary bladder (p = 0.007) and the treatment success with regard to image quality significantly worse (p = 0.007). Conclusion: The Ambu^® aScope™ 4 Cysto Reverse Deflection shows high satisfaction values among users in clinical routine. In analogy to other studies with flexible endoscopes, urologists with more professional experience show higher satisfaction values than examiners with less training in flexible endoscopy.

A portrait of Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound training programs in Europe: Current practices and opportunities for improvement.

Endoscopic retrograde cholangiopancreatography (ERCP) and EUS are challenging procedures requiring a high level of expertise to provide effective and safe patient care. Thus, high-quality training is needed to achieve competence. We aimed to evaluate the status of European ERCP/EUS training programs, to evaluate adherence to international recommendations, and to propose possible solutions for future improvements. A web-based survey was developed and ERCP/EUS experts and trainees across Europe were invited to participate. Forty-one experts (out of 50; 82%) and 30 trainees (out of 70; 42.9%) from 18 countries answered the questionnaire. The training program application process is mainly driven by individual requests (87.8%). All surveyed departments offer combined ERCP/EUS training and the majority have adequate facilities and trainers. Although centers are high-volume and provide long-term fellowships, trainee hands-on exposure is not very high (43% expect to do (or did) 100-150 ERCPs and 69% up to 150 EUSs). A formal curriculum is in place in 53.7% centers, including simulation-training in 27.3%. Competence is assessed in 65.7% of centers, but validated tools are applied in only 33.3%. This survey first provides an overview of ERCP/EUS training programs across Europe. It shows that there is adherence to international guidelines to a certain degree, but several gaps in the application process, use of simulators for training, training curriculum and assessment of performance have been recognized. Overcoming these shortcomings could serve as a basis for further improvement in ERCP/EUS training.

The future of endoscopy training: a view from the North West of England

Health Education England has created seven endoscopy training academies across England. These will oversee the multidisciplinary training of all endoscopy staff on a regional basis to address the challenges of waiting times and recovery, which are often limited by human resources. This article outlines the North West vision for the future of endoscopy training and how it will impact on all staff, for the benefit of patients.