Virtual reality training for gastrointestinal endoscopy: A systematic review of efficacy and outcomes

Table 1 Characteristics of the included studies

Ref.	Setting	Study design	Sample size	Level of training
Piskorz et al[4], 2020	Argentina	Pre- and post-test trial	126	PGY1 gastroenterology residents
Van Sickle et al[5], 2011	United States	Pre- and post-test trial	41	PGY1-4 general surgery residents
Telem et al[6], 2014	United States	Pre- and post-test trial	9	Novice surgical interns
Shirai et al[7], 2008	Japan	RCT	20	PGY1 and PGY2 residents in the gastroenterology and hepatology department
Gerson and Van Dam[8], 2003	United States	RCT	16	Internal medicine residents
Koch et al[9], 2015	Netherlands	RCT	18	Residents starting their gastroenterology training
Ferlitsch et al[10], 2002	Austria	RCT	24	Medical residents and experienced endoscopists
Silva Mendes et al[11], 2022	Portugal	Pre- and post-test trial	23	First-year gastroenterology residents
Buzink et al[12], 2007	Netherlands	Pre- and post-test trial	30	Medical interns or residents in training
McIntosh et al[13], 2014	United Kingdom	RCT	18	Residents PGY2 to PGY4
Park et al[14], 2007	Canada	RCT	24	Residents in internal medicine and gastroenterology in PGY1 to PGY3
Gomez et al[15], 2015	United States	RCT	27	Surgical PGY1 residents
Cohen et al[16], 2006	United States	RCT	45	Gastroenterology fellows
Grover et al[17], 2015	United States	RCT	34	Residents in internal medicine, gastroenterology, and general surgery
Vajpeyi et al[18], 2025	Canada	Pre-test post-test trial	33	Eight expert endoscopists and 25 novice endoscopists
Gao et al[19], 2019	China	RCT	27	Clinical doctors
Arnold et al[20], 2015	Denmark	Pre-test post-test trial	37	Senior doctors, medical doctors, and medical students
Bittner et al[21], 2010	United States	Pre-test post-test trial	12	Six were novice endoscopists, and 6 were expert endoscopists
Sahakian et al[22], 2016	United States	NRCT	10	Four gastroenterology faculty and six fellows
Ferlitsch et al[23], 2010	Austria	RCT	28	28 residents
Georgiou et al[24], 2023	Bulgaria	NRCT	37	7 expert endoscopists and 31 novices
Sedlack[25], 2007	United States	RCT	29	Gastroenterology fellows with different levels of experience
Sedlack et al[26], 2004	United States	RCT	38	PGY2 internal medicine residents
Sedlack and Kolars[27], 2004	United States	RCT	8	First-year GI fellows
Haycock et al[28], 2010	Netherlands, Italy, and the United Kingdom	RCT	36	Novice colonoscopists
Di Giulio et al[29], 2004	Italy	RCT	22	Gastroenterology fellows
Ahlberg et al[30], 2005	Sweden	RCT	22	12 residents and 10 surgeons
Grover et al[31], 2017	Canada	RCT	37	Novice endoscopists
Ende et al[32], 2012	Germany	RCT	28	Medical and surgical residents

PGY: Postgraduate year; RCT: Randomized controlled trial; NRCT: Non-randomized controlled trial; GI: Gastrointestinal.

Table 2 Procedure characteristics from the selected studies meeting the inclusion criteria

Ref.	Type of virtual training	Endoscopic procedure	Description of procedure	Number of sessions	Outcome assessment
Van Sickle et al[5], 2011	GI mentor II	Colonoscopy	Basic colonoscopy with no anatomical or pathological variation	The trainees needed to achieve proficiency in two tasks before proceeding to another level of training in a maximum of 10 trials	Performance data, training data, and subjective self-evaluation data
Telem et al[6], 2014	GI mentor	Colonoscopy	12-hour GI mentor independent training	2-hour sessions each week for 6 weeks	Performance based on the GAGES-C criteria
Piskorz et al[4], 2020	GI mentor II	Gastroscopy and colonoscopy	8-hour work day	-	Performance data
Shirai et al[7], 2008	GI mentor II	EGD	1-hour training sessions	Five sessions over two weeks	The performance time taken by each trainee group to reach the various stages of EGD
Gerson and Van Dam[8], 2003	-	Sigmoidoscopy	The virtual reality group had unlimited time for 2 weeks. The traditional bedside group had only ten sessions to practice	-	Performance of the residents, including the number of procedures completed independently, those requiring assistance, flexure recognition, and retroflexion
Koch et al[9], 2015	GI mentor II	Colonoscopy	One session included at least five consecutive colonoscopies	They included 10-20 sessions distributed over 5 weeks to 10 weeks	The insertion depth and the rate of cecal intubation during patient-based assessments
Ferlitsch et al[10], 2002	GI mentor	Gastroscopy and colonoscopy	2-hour sessions	5 sessions a week, for 3 weeks	Performance of the trainees in the endobubble, endobasket, and virtual endoscopy cases
Silva Mendes et al[11], 2022	GI mentor II	EGD and colonoscopy	5-hour sessions	One session each week for about 3-4 weeks	Cognitive evaluation of the resident’s performance, endoscopy skill assessment in both EGD and colonoscopy
Buzink et al[12], 2007	GI mentor II	Colonoscopy	Not described	1 session per day for five consecutive days	Performance time
McIntosh et al[13], 2014	GI mentor II	Colonoscopy	The training was to be carried out for a total of between 10 hours and 20 hours	The sessions were distributed over four weeks	Number of proctor assists required per colonoscopy, the procedure time, and the rate of successful cecal intubation
Park et al[14], 2007	AccuTouch colonoscopy simulator	Colonoscopy	The training period was for a period of 2 hours to 3 hours	Not specified	The performance data includes caecum intubation, lack of flaws, and global ratings as assessed by an independent evaluator
Gomez et al[15], 2015	GI mentor II and Kyoto Kagaku colonoscopy	Colonoscopy	-	The total training was for 3 weeks	Performance time and the evaluator rating using the GAGES scores
Cohen et al[16], 2006	GI mentor	Colonoscopy	2-hour session on the simulators	Five sessions over 8 weeks	Objective and subjective competence of the fellows, and the discomfort scores
Grover et al[17], 2015	EndoVR virtual reality endoscopy simulator	Colonoscopy	8 hours of supervised endoscopy sessions	Not reported	JAG DOPS scale scores and performance data
Vajpeyi et al[18], 2025	M40 colonoscope training simulator	Colonoscopy	-	-	Performance data, including performance time
Gao et al[19], 2019	GI mentor II	EUS	-	All the training was carried out over 8 weeks	Test scores after completion of training
Arnold et al[20], 2015	GI mentor II	ERCP	-	-	Motion movement as demonstrated by the different groups of endoscopists according to the level of expertise
Bittner et al[21], 2010	GI mentor II	ERCP	They performed supervised 30-minute sessions	Each participant completed three cases	Validity of the VR tool as a simulator for ERCP
Sahakian et al[22], 2016	Endo VR	ERCP	The participant had unlimited time to complete cases	Each participant completed 6 cases	Procedure time and patient discomfort
Ferlitsch et al[23], 2010	GI mentor	Upper GI endoscopy	2-hour sessions	The participants completed training sessions for as long as 20 hours	Patient discomfort and pain
Georgiou et al[24], 2023	GI mentor	ERCP	3 procedures	-	Performance time
Sedlack[25], 2007	GI Mentor	EGD	15-minute introduction session, then the participant completed the training for 6 hours	The total simulation training included up to 20 simulated cases	Performance data, including procedure time and endoscopy skills
Sedlack et al[26], 2004	AccuTouch VR	Sigmoidoscopy	The participants had simulation training for a total of 3 hours	The total simulation training included 8-10 simulated cases	Subjective and objective assessment of the resident's sigmoidoscopy competency
Sedlack and Kolars[27], 2004	AccuTouch VR	Colonoscopy	The participants received simulation training for about 6 hours	The simulation involved 20-25 cases spread over two days	Objective assessment of the fellows’ performance, including performance time
Haycock et al[28], 2010	Endo TS-1 Olympus	Colonoscopy	The participants received four half-day sessions, leading to 16 hours of simulation training	The sessions were distributed over four days	Colonoscopy proficiency as assessed using the JAG DOPS and Global score
Di Giulio et al[29], 2004	GI mentor	EGD	The participants completed 10 hours of simulation training	The simulation involved 10 cases to be covered in 3 sessions to 5 sessions	Procedure time, rate of successful intubation, and the reasons for failed or assisted intubations
Ahlberg et al[30], 2005	AccuTouch VR	Colonoscopy	-	-	Procedure time and reason for procedure termination, if applicable
Grover et al[31], 2017	Accutouch VR	Colonoscopy	The participants received 4 hours of interactive didactic sessions and 6 hours of supervised simulator training	-	The performance of endoscopists in the two different topics was assessed by the JAG DOPS assessment tool
Ende et al[32], 2012	GI mentor, plastic phantom, and compactEASIE	EGD	The simulation training consisted of 2-hour sessions for a total of 10 hours	Five training sessions distributed over five weeks	Performance data including procedure time and the number of instances where residents required assistance
Hashimoto et al[33], 2018	GI mentor	Colonoscopy	Each participant had to complete a repetitive task in colonoscopy for the FES program	Ten repetitions for each task in the repetitions group. The proficiency group repeated each task until they met the proficiency benchmark in two consecutive tasks	Pass rate and FES scores of each of the participants

GI: Gastrointestinal; FES: Fundamentals of endoscopic surgery; GAGES-C: Global Assessment of Gastrointestinal Endoscopic Skills-Colonoscopy; EGD: Esophagogastroduodenoscopy; ERCP: Endoscopic retrograde cholangiopancreatography; VR: Virtual reality; JAG DOPS: Joint advisory group direct observation of procedural skills; EUS: Endoscopic ultrasound; VR: Virtual reality; AccuTouch VR: AccuTouch virtual reality simulator; EndoVR: Endo virtual reality simulator; TS-1 Olympus: Endoscopy simulator model name; compactEASIE: Compact compact Erlangen Active Simulator for Interventional Endoscopy.