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

BACKGROUND Traditional gastrointestinal endoscopy (GIE) apprenticeship training raises concerns regarding patient safety, prompting growing adoption of simulation-based training approaches. Virtual reality (VR) simulators provide a risk-free, learner-centered environment in which trainees can develop and refine endoscopic skills prior to clinical practice. Although VR-based training has been increasingly implemented worldwide, its efficacy relative to conventional training methods has yet to be conclusively established. AIM To evaluate the effectiveness and outcomes of VR-based training in GIE through a systematic review of interventional studies. METHODS This systematic review followed PRISMA 2020 guidelines. PubMed, ScienceDirect, and Google Scholar were searched through June 2025 using Boolean combinations of terms related to VR, simulation, and GIE. Eligible studies were interventional trials evaluating VR-based training that reported changes in endoscopist competency. Procedures included esophagogastroduodenoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound. RESULTS VR-based training consistently improved trainee competency, procedural independence, and patient safety compared with baseline performance, with outcomes comparable to conventional training. In esophagogastroduodenoscopy, VR simulation significantly increased independent procedure completion rates (odds ratio: 65.7; 95% confidence interval: 20.1-214.4) and achieved similar procedure times to traditional training (10.5 minutes vs 12.4 minutes). In endoscopic retrograde cholangiopancreatography, VR effectively differentiated skill levels, with experts outperforming novices in key metrics such as papilla visualization and cannulation time (P < 0.05). Endoscopic ultrasound competency improved when VR was combined with clinical training (64.53 ± 4.91 vs 60.09 ± 5.49; P = 0.028). Colonoscopy studies reported higher pass rates and improved objective skill scores in VR-trained groups (100% vs 88.9% pass rate in proficiency-based VR training). CONCLUSION These findings support integrating VR simulation as an adjunct to conventional endoscopy training and underscore the need for standardized training frameworks and further research to optimize implementation and assess long-term clinical impact.