Training for Advanced Endoscopic Imaging in Gastrointestinal Diseases

Advanced endoscopic imaging is an emerging field in endoscopy practice, especially in optical diagnosis. Current technologies like virtual chromoendoscopy and small-field technologies allow visualization of subtle changes in mucosal and vascular patterns that are predictive of histology. The limiting factor in broadly utilizing these techniques is training and the need for reliable detection of these subtleties. This review provides the current evidence and limitations of training in advanced endoscopic imaging, and future directions of learning. A literature search was performed on PubMed and Medline through March 2020 with relevant keywords as advanced endoscopic imaging, training, and learning. References of relevant articles were screened for additional literature. Several didactic and web-based education programs are developed for training in virtual chromoendoscopy, autofluorescence imaging, confocal laser endomicroscopy, and volumetric laser endomicroscopy. Studies and post-hoc analysis on learning curves showed relatively steep learning curves after training, and web-based education seems to be as valuable as in-person didactic training for most techniques. However, consistent performance on expert level after training has not yet been demonstrated. Most advanced endoscopic imaging techniques are learned within a reasonable timeframe. Future efforts to enhance training and implementation of these techniques should focus on developing standardized and broadly incorporated training programs. The future role of artificial intelligence-assistance in advanced endoscopy and training has to be elucidated.