Virtual reality in GI endoscopy: intuitive zoom for improving diagnostics and training.

Among the many areas which may benefit from virtual reality (VR), GI endoscopy could be an important one. We developed a system to magnify the endoscopic image on forward movement of the endoscopists head to zoom into areas of interest during real-time endoscopy, called intuitive zoom. We could show that VR could be conveniently incorporated into daily endoscopic work when it comes to closely examining operator-defined regions of interest. Additionally, applied light intensity-derived three-dimensional (3D)reconstruction of the intestinal mucosa was used to better assess lesions such as polyps using the Paris classification. These new techniques might improve routine endoscopic diagnosis and therapy and open a new world of endoscopic training.### Study backgroundFlexible endoscopy is performed using a two-dimensional (2D) image of the working area. Although this is regarded as a standard since 1970,1 new technologies allowing for stereoscopic vision thus improving visual spacial perception emerge. VR is used to generate realistic images that replicate a real environment by using head mounted displays (HMDs). Since 2016, after the introduction of the HMDs Oculus Rift (Oculus VR, California, USA) and HTC VIVE (HTC, New Taipei City, Republic of China), the technology became available at consumer prices. Until now, VR is often used for training purposes like surgical training.2 3 VR is also used for endoscopic training although most simulators just project a virtual endoscopic image on a flat screen without full immersion of the examiner.4–6 To explore the potential of VR in real-time flexible endoscopy, we developed a setup for performing endoscopic interventions aided by special features that can be easily implemented in VR.### MethodsEndoscopic examinations were performed using an Olympus GIF-HQ190 and CF-HQ190I (Hamburg, Germany). VR was implemented using the headset HTC VIVE accompanied by the VIVE Tracker. Interaction of the user with the devices was programmed using the cross-platform …