Virtual reality simulation in training endoscopic skills: A systematic review

Objective:Training young physicians in gastrointestinal endoscopy through virtual reality(VR)simulators has become popular.It is important to evaluate the benefits and usefulness of this technology for teaching endoscopic skills.The objective of this literature review is to understand the benefits of VR technology through quantitative and qualitative examination of learning outcomes.Methods:A literature search of 7 databases was conducted.Studies which compared the effects of learning through VR simulation and another method of learning were included.In addition,studies were included if they evaluated learning outcomes on clinical patients.Participants could be medical residents,fellows,physicians,or nurses.Common outcomes measured across studies included subjective overall performance scores,total procedure times,rate of successful procedure completion,error rates,patient pain or discomfort,and measures of independence.Results:A total of 22 studies were included.Overall,VR simulation training was seen to be comparable or significantly better than clinical training,no training,other types of simulation,and another form of VR training.Many authors reported increasing patient safety,reducing stress and time constraints,and shortening the learning curve as advantages of VR simulation training.However,this form of training is also expensive and may result in the learning of bad habits.Conclusion:VR simulation technology can be a valuable form of educating endoscopy novices if properly supervised during training,and if there is also integration of clinical training.

Safety and success of precut biliary sphincterotomy: Is it linked to experience or expertise?

AIM： To determine the rates of success and complications of precut biliary sphincterotomy （PBS） based on prior experience and to compare the complication rates between PBS and standard endoscopic sphincterotomy （ES）. METHODS： A retrospective evaluation of prospectively collected non-randomized data at an academic tertiary referral center, The study included all patients in an eight-year period who underwent PBS and ES by a single endoscopist who had no formal training in PBS. The main outcorne measures of the study were success and complications of PBS with a comparison to complications of ES.RESULTS： A total of 2939 endoscopic retrograde chola ngiopancreatographies （ERCPs） were performed during the study period, including 818 （28%） ES and 150 （5%） PBS procedures. Selective biliary cannulation via PBS was successful at the first attempt in 75% of the patients. Cannulation was achieved in an additional 13% of the patients at a subsequent attempt （total 87%）. Complication rate from PBS was 45% higher than ES, but did not differ significantly [7% （10/50） vs 5% （38/818）, P = 0.29]. None of the complications from PBS was severe. A significant trend towards increasing success existed with regard to the endoscopist＇s first attempt at precut （P = 0.0393, Cochran-Armitage exact test for trend, Z = -1.7588）. CONCLUSION： Despite the lack of specific training in this technique, PBS was performed with a high success rate and a complication rate similar to or less than reports from other experienced centers. These results suggest that endoscopic experience and perhaps innate endoscopic skill may play an important role in the outcome of this procedure.