OC-084 Feasibility of endogel(tm) simulation training for per-oral endoscopic myotomy (poem): first united kingdom experience

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Simulation-based training is an established method of basic endoscopic training, however this is limited in advanced endoscopic techniques due to challenges in creating realistic environments. Uptake of advanced endoscopic techniques in the West has also been slower compared to the East due to lack of structured training programmes. Porcine model training is limited in availability and subject to local ethical approval emphasising the need of an alternative simulation medium. Here we evaluate the feasibility of UK’s first EndogelTM (Sunarrow Ltd, Japan) simulation course for POEM with video demonstration of technique.


Eight delegates undergoing a single POEM training course were included. All delegates received a didactic lecture including video demonstration of POEM. This was followed by a live demonstration of POEM technique using EndogelTM. Orientation of EndogelTM was as per manufacturers guidance for POEM training. Prospective data on baseline POEM experience were collected. Assessment of EndogelTM for realism, feasibility and usefulness in POEM simulation training was recorded using a 5-point Likert scale (5 being the “best” score) and analysed using median and range values.


All course delegates were UK practitioners (6 gastroenterologists, 2 surgeons, 1 senior trainee and 7 consultants) and received prior lecture based training. 3 had completed previous a hands-on course including 2 with previous POEM simulation training. 3 delegates had fellowship(n=2)/observership (n=1) experience. 2 delegates had some primary operator experience (5–10 and >10 POEM). Median score was 4 for realism of EndoGelTM orientation (3-5), mucosal lift (4-5), mucosal incision (3-5), submucosal expansion (3-5) and myotomy (3-5). Realism of submucosal dissection scored higher at 5 (3-5). Median score was 4 for feasibility of EndoGelTM orientation (3-5), mucosal lift (4-5), mucosal incision (1-5), submucosal expansion (3-5), submucosal dissection (1-5) and myotomy (3-5). This cohort found the EndogelTM simulator useful (4, 4-5) and would use this again (4, 3-5) including monitoring skill development (4, 3-5).


This preliminary data supports EndogelTM as a feasible simulation model for POEM training for trainees of varied experience. Particular attractive features are the realism of submucosal dissection owing to the specifically designed liquid retaining submucosal plane of the layered polyvinyl alcohol hydrogel enabling precise dissection to be mastered. Additionally, EndogelTM is advantageous over porcine models in being reusable. EndogelTM provides a safe and efficacious environment for advanced endoscopic skill development in the West.

Disclosure of Interest

None Declared

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