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

Area of Science:

• Gastroenterology
• Surgical Education
• Medical Training

Background:

• Endoscopic submucosal dissection (ESD) is a curative treatment for superficial gastrointestinal neoplasia.
• Structured training is essential for ESD proficiency, yet real-world practices and challenges are not well understood.
• Existing European Society of Gastrointestinal Endoscopy (ESGE) and American Society for Gastrointestinal Endoscopy (ASGE) curricula require further evaluation in practice.

Purpose of the Study:

• To assess current endoscopic submucosal dissection (ESD) training opportunities and barriers.
• To evaluate adherence to established ESGE/ASGE curricula across different training centers.
• To identify regional disparities and influencing factors in ESD training quality and accessibility.

Main Methods:

• An anonymous, 55-item web-based survey was distributed to trainees and trainers.
• Data collection occurred from April to July 2025, assessing training methods, curriculum adherence, barriers, and quality metrics.
• Responses were stratified by professional role (trainee/trainer) and annual endoscopic submucosal dissection (ESD) volume.

Main Results:

• 288 responses were received from 39 countries, revealing significant variations in structured training completion (47.2%) and curriculum adherence (46.5%).
• High-volume centers demonstrated higher curriculum adherence (69.6%) compared to low-volume centers (26.8%), with lack of training models being a common barrier (46.5%).
• Leading barriers included lack of simulators, fellowship costs, and time constraints, while in vivo human training, animal models, and intensive courses were preferred. Regional disparities were evident, with resource and financial constraints impacting training in certain areas.

Conclusions:

• Substantial international disparities exist in endoscopic submucosal dissection (ESD) training quality and accessibility.
• Coordinated global efforts are necessary to enhance access to structured ESD curricula, mentorship, and affordable training models.
• Addressing resource limitations and financial barriers is critical for equitable ESD training worldwide.