A low-cost ex vivo simulator for training in endoscopic hemostasis and perforation management.

BACKGROUND AND AIMS: High-risk endoscopic interventions (bleeding control and perforation closure) require deliberate, repeated practice, yet structured hands-on training is scarce. We developed a Muscat Endoscopy Academy Gastric Simulator (MEA-GASTROSIM), a compact, reusable ex vivo upper-GI simulator built from low-cost, locally sourced materials, aligned with international recommendations supporting simulation in competency-based endoscopy training. METHODS: The system uses a custom-made stomach-shaped wooden mold on a stable pedestal, lined with a 2-component silicone layer and an aluminum conductive layer, and covered with ex vivo animal stomach tissue. A transparent acrylic cover recreates the confined working field and permits instructor visualization; a lateral access port approximates esophageal entry. Bleeding is simulated by colored-fluid injection and subtissue tubing connected to syringes for pressure-controlled, pulsatile flow. Perforations and resection-type defects are created as tailored tissue defects to practice endoscopic closure. RESULTS: MEA-GASTROSIM supports repeatable, escalating scenarios of oozing and spurting hemorrhage and clinically relevant defects, enabling practice of lesion identification, device selection, injection, clipping, coagulation, and closure, including suturing with immediate feedback. CONCLUSIONS: MEA-GASTROSIM offers a realistic, affordable platform for progressive skill refinement in hemostasis and perforation management without exposing patients to risk.