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

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.

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Artikel online veröffentlicht:
27. März 2025