The increasing demand for endoscopy as both a diagnostic and therapeutic tool must be supported by the development of endoscopy training. Confidence in endoscopic skills is particularly critical when managing acute scenarios such as upper gastrointestinal bleeds (UGIB).

Recent endoscopy trainee surveys in the UK have highlighted the deficits in haemostasis training, accompanied by low reported confidence and independence. Techniques such as glue injection and Danis stent are particularly difficult skills to train in, and trainees have called for further simulation-based training.

An innovative method using ex vivo animal tissue was introduced to assist in training such endoscopy techniques.

A half-day consultant-run course was developed with a focus on utilisation of porcine stomachs, supplemented with pre-course reading and handbook. We created a low-cost porcine model by drilling holes into a black box in which overtubes were used to keep the porcine stomachs patent. Bleeding was simulated using cannulas which allowed red dye to flow into the stomach.

The stations were split into variceal haemostasis and non-variceal haemostasis. Participants received hands on experience banding oesophageal varices, gluing gastric varices, inserting Danis stent and inserting Sengstaken-Blakemore tube in the variceal haemostasis station.  In the other, they practised using the gold probe, injecting adrenaline, and using through-the-scope clips and over-the-scope clips.

Between 2021 and 2025, four sessions of training were hosted. 54 responses of qualitative feedback were received. Participants reported high levels of satisfaction with the course, particularly the opportunity for hands-on experience and live demonstration.  A prominent theme was the value of the haemostasis station, particularly the ability to practise glue injection and Danis stent deployment.  These are techniques in which endoscopy trainees have previously reported low independence and limited experience. Participants also described the benefit in practising over-the-scope clips, a procedure in which trainees have been found to have little or no encounters with.

Another recurring theme from participants was the simulation of both technical skills and working within the multidisciplinary team during these scenarios. Participants cited the benefits in practising communication with other healthcare professionals within the endoscopy team. Suggestions for improvement included increasing the time per station and expanding the range of endoscopic techniques taught, such as those related to nutrition interventions.  

The use of ex vivo porcine tissue in simulating UGIB provides a low-cost and effective method of endoscopy training provision. This method of teaching offers practical experience and directly addresses previously suggested improvements to haemostasis endoscopy training using simulation. Participant feedback emphasises the value of hands-on experience in a variety of interventions and highlights the opportunity in using this model for other endoscopic interventions, including nutrition-related procedures.