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Bariatric endoscopy is a novel and expanding field in gastrointestinal (GI) endoscopy [1]. The most common bariatric endoscopy procedure is intragastric balloon (IGB) placement [2]. Currently most training occurs with a proctor and a patient. Of course, this approach has potential ethical disadvantages [3], and obtaining the skills for IGB placement using an ex vivo hands-on model would be an ideal solution [4]. We developed a novel mechanical simulator for endoscopic hands-on training with the IGB procedure (LELLA model; EndoWorks LLC, Florida, USA). The model consists of a transparent polycarbonate resin phantom with a fully accessible upper GI tract (▶Fig. 1; ▶Video1). The IGB placement is carried out step by step with endoscopic, as well as external, visual control, which allows an extended comprehensive view of the physics applied in IGB placement and retrieval (▶Video1). The esophagus was developed from a plastic conduit of 3 cm in diameter. It connects proximally to a standard mouthpiece and distally to a red rubber ring, which simulates the gastroesophageal junction and cardia region, an important anatomical landmark for the IGB procedure. The stomachmodel is a round acrylic based chamber of 20 cm in diameter and supports all Food and Drug Administration (FDA)-approved single IGBs. For the purpose of this video, we used the Spatz 3 Adjustable Balloon System (Spatz FGIA, Inc., New York, USA) (▶Fig. 2). The IGB was filled with 600mL of purple isotonic drink (Gatorade) allowing several reuses of the device and thereby reducing the costs associated with training (▶Fig. 2). IGB systems that require drilling are an exception as they are ruptured after one use. In addition, the use of isotonic drinks avoids staining the prototype, which can be an issue when using a saline and methylene blue solution. Balloon emptying is carried out after retrieving the retractile drainage catheter with a rat-tooth forceps and aspirating the fluid using a negative pressure aspiration system (▶Fig. 2; ▶Video1). After endoscopically confirming complete shrinkage of the IGB, the decompressed balloon is withdrawn through the esophagus and mouthpiece. E-Videos

A novel mechanical simulator for hands-on bariatric endoscopy training in intragastric balloon placement