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CC BY-NC-ND 4.0 · Endosc Int Open 2026; 14: a28133195
DOI: 10.1055/a-2813-3195
Original article

Real-world practices and barriers in endoscopic submucosal dissection training: International comprehensive survey

Autor*innen

  • Giulio Calabrese 

    1   Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy (Ringgold ID: RIN9307)

  • Marcello Maida 

    2   Department of Medicine and Surgery, Kore University of Enna, Enna, Italy (Ringgold ID: RIN217140)
    3   Gastroenterology Unit, Umberto I Hospital, Enna, Enna, Italy

  • Shaimaa Elkholy 

    4   Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt (Ringgold ID: RIN63527)

  • Manol Jovani

    5   Gastro Health, Miami, Baptist Health, Florida International University, Florida, United States (Ringgold ID: RIN22377)

  • David J Tate

    6   Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium (Ringgold ID: RIN60200)

  • Hugo Uchima 

    7   Endoscopy Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (Ringgold ID: RIN16514)
    8   Endoscopy Unit, Centro Médico Teknon, Barcelona, Spain (Ringgold ID: RIN16711)

  • Yohei Minato

    9   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan (Ringgold ID: RIN13635)

  • Partha Pal 

    10   Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Ringgold ID: RIN78470)

  • Sunil Gupta 

    11   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
    12   Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia (Ringgold ID: RIN216997)

  • Rui Morais 

    13   Gastroenterology, Centro Hospitalar de Sao Joao, Porto, Portugal (Ringgold ID: RIN285211)

  • Torsten Beyna

    14   Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany

  • Jeremie Jacques

    15   Service d'hépato-gastro-entérologie, CHU Limoges, Limoges, France (Ringgold ID: RIN36715)

  • Sandro Sferrazza

    16   Gastroenterology and Endoscopy Unit, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy (Ringgold ID: RIN367405)
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Abstract

Background and study aims

Endoscopic submucosal dissection (ESD) enables curative resection of superficial gastrointestinal neoplasia but requires structured training. Although European Society of Gastrointestinal Endoscopy (ESGE)/American Society for Gastrointestinal Endoscopy (ASGE) curricula exist, real-world practices and barriers remain unclear.

Methods

We conducted an anonymous web-based survey (April–July 2025) with 55 items assessing training opportunities, barriers, curriculum adherence, and quality metrics, stratified by role and annual ESD volume.

Results

We received 288 responses (137 trainees, 151 trainers) from 39 countries across five geographic macro-areas. Nearly half (47.2%) had undertaken structured training, but only 46.5% fulfilled ESGE/ASGE curricula, with marked variation by center volume (69.6% in high-volume vs 26.8% in low-volume, P < 0.001). Lack of access to training models was reported by 46.5% overall, more frequently in low-volume centers. In vivo human training, animal models, and intensive courses were rated highest, whereas lack of simulators, fellowship costs, and limited time were leading barriers. Quality monitoring was reported in 62.5% of centers, prioritizing R0 and en bloc resection rates over procedure speed. Trainees valued traction and underwater techniques more than trainers. Regional differences were pronounced: North-West Europe and Asia-Pacific concentrated high-volume centers and greater curriculum adherence, whereas Africa/Middle East and South-East Europe faced resource and financial constraints.

Conclusions

This international survey reveals substantial disparities in ESD training and calls for coordinated efforts to improve access to structured curricula, mentorship, and affordable training models.

Keywords

Endoscopy Lower GI Tract - Polyps / adenomas / ... - Endoscopic resection (polypectomy, ESD, EMRc, ...) - Quality and logistical aspects - Training

Supplementary Material



Publikationsverlauf

Eingereicht: 10. Oktober 2025

Angenommen nach Revision: 12. Februar 2026

Accepted Manuscript online:
16. Februar 2026

Artikel online veröffentlicht:
06. März 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Giulio Calabrese, Marcello Maida, Shaimaa Elkholy, Manol Jovani, David J Tate, Hugo Uchima, Yohei Minato, Partha Pal, Sunil Gupta, Rui Morais, Torsten Beyna, Jeremie Jacques, Sandro Sferrazza. Real-world practices and barriers in endoscopic submucosal dissection training: International comprehensive survey. Endosc Int Open 2026; 14: a28133195.
DOI: 10.1055/a-2813-3195
 

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