Endoscopic angle manipulation training for endoscopic submucosal dissection: an attachable transparent sheet

Open AccessPublished:March 15, 2018DOI:
      Several training methods that seek to improve various colorectal endoscopic mucosal dissection (ESD) techniques have been reported. Many basic techniques, including left-right angle manipulation, turning the left hand, or twisting or fixing of the endoscope using the left hand are required for accurate control of the endoscope during colorectal ESD besides up-and-down angle manipulation. The endoscopist needs to master these techniques to perform safe and efficient colorectal ESD. We have developed an attachable transparent sheet to improve endoscopic angle manipulation (Video 1, available online at
      To use this sheet, first the length of the endoscope screen used in the facility is measured. Next, a commercially available transparent sheet that is slightly larger than the measured size is obtained, and lines are drawn on the transparent sheet in 16 directions, including at 1:30, 4:30, 7:30, and 10:30, with a clock face used as a guide. The transparent sheet is then attached to the endoscope screen with tape (Fig. 1A).
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      Figure 1A, Creation of an attachable transparent sheet. Lines are drawn on a sufficiently large transparent sheet in 16 directions, including at 1:30, 4:30, 7:30, and 10:30 (using a clock face as a guide). B, Creation and use of anattachable transparent sheet.
      We conducted endoscopy training for endoscopic angle manipulation using the transparent sheet and the EGD Simulator (Model LM0-22; KOKEN Co, Ltd, Toshima-ku, Tokyo, Japan). Video 1 (available online at and Figure 1B show the animation and the actual colorectal ESD. Training involves accurately moving the endoscope tip in the 16 directions and also drawing circles using the tip. Clinicians can improve the stability of their operative movements by facilitating the development of manual manipulation skills (ie, placement of the left thumb, middle, and ring fingers, as shown in Video 1), which allows for greater control over the up-and-down and left-to-right endoscopic angle levers. Ultimately, moving the endoscope tip in the intended direction is important for performing ESD, during which the endoscope tip is often moved parallel to the muscular layer.
      To improve the angle manipulation of the endoscope, training, as described here, along with daily endoscopy practice, is needed. We have developed and applied a transparent sheet that improves the practitioner’s skill at manipulating the endoscopic angle.


      All authors disclosed no financial relationships relevant to this publication.

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