First evaluation of a novel colonoscopy simulator with elongation feedback comparing short vs. long colonoscope performance

Endoscopy, vol. 57

Abstract

Aims The implementation of high-quality training in colonoscopy remains challenging and different preferences for short and long colonoscopes exist. In this study, we evaluated a novel colonoscopy simulator for the first time. The artificial bowel contains multiple pressure and elongation sensors allowing to evaluate the strain induced by a real colonoscope on the bowel model. The aim was to i) evaluate the simulator’s feasibility and ii) to objectively compare the performance using a short vs. a long colonoscope. Methods We invited endoscopists participating at a German national meeting (DGE-BV 2024) or ESGE days 2024 to evaluate the Mikoto simulator. Out of 281 participants, 252 complete data sets (65 DGE-BV, 187 ESGE) were analyzed. Endoscopists were offered to perform two rounds (using a standard long and short colonoscope) with the same settings. 107 participants started with a short scope and performed the second round with a long scope and 107 did the opposite while 21 and 17 used only the long or the short scope, respectively. Afterwards, every participant filled out a survey (e.g. endoscopy experience, evaluation of the simulator, System-Usability-Scale (SUS)). The primary endpoint was time to reach the cecum, secondary endpoints were Mikoto objective measures. Results i) For all participants, there was a positive correlation between Mikoto-Score and self-assessment of experience (r=0.43, p<0.001) and between Mikoto-Score and amount of performed colonoscopies (r=0.47, p<0.001). 63.9% of endoscopists evaluated the simulator as realistic and very useful for trainees with low and average experience. The SUS was 74.4 out of 100 points corresponding to a good usability. ii) Comparing the first round, the long scope group had a tendency of reaching the cecum later than the short scope group (04:23 vs. 03:46 min, p=0.09). Comparing the second round, the cecum was reached in 03:49 min in the long scope group vs. 03:46 min in the short scope group (p=0.80). Analyzing the first vs. the second round in the same individuals, the time to reach the cecum improved about 37 seconds (p=0.10) using the long scope first and about 6 seconds using the short scope first (p=0.80). Comparing short vs. long scope, there was no significant difference in cecal intubation rate (88.8% vs. 90.7%) or overall Mikoto-Score (61.6 vs 67.8). Likewise, the sigmoid-colon pressure sensor score (1.7 vs. 2.1) and sigmoid-colon pressure active time (37s vs. 29s) were comparable while the sigmoid-colon elongation score (26.9 vs. 31.3, p=0.07) and overall elongation score (25.2 vs. 29.2, p=0.07) showed a non-significant tendency favouring the short scope. Conclusions The Mikoto colonoscopy simulator was evaluated as realistic training model and showed a good correlation with an endoscopist’s experience. No relevant differences were detected using the short vs. long standard colonoscope. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Authors 9

1. Karim Hamesch Aachen Interdisciplinary Endoscopy

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Interdisciplinary Endoscopy, University Hospital RWTH Aachen, Aachen, Germany

2. Christian Gerges

   Essen University Hospital

   Affiliation as printed

   University Hospital Essen, Essen, Germany

3. Mate Knabe

   University Hospital Frankfurt

   Affiliation as printed

   Frankfurt University Hospital, Frankfurt am Main, Germany

4. Stavros Dimitriadis
   Affiliation as printed

   Unit of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Glifada, Greece

5. Carola Fleischmann

   Nuremberg Hospital

   Affiliation as printed

   Nuremberg Hospital North, North Hospital, Nürnberg, Germany

6. L Welsch

   Klinikum Hanau

   Affiliation as printed

   Klinikum Hanau, Hanau, Germany

7. F Michael

   University Hospital Frankfurt

   Affiliation as printed

   Frankfurt University Hospital, Frankfurt, Germany

8. Oscar Cahyadi

   St. Josef-Hospital

   Affiliation as printed

   Catholic Hospital Bochum – St. Josef-Hospital, Bochum, Germany

9. Marcus Hollenbach

   Philipps University of Marburg · Universitätsklinikum Gießen und Marburg

   Affiliation as printed

   University of Marburg Medical Center, Marburg, Germany