Training in endoscopic submucosal dissection: Current models and future needs

Endoscopic submucosal dissection (ESD) has transformed the management of superficial gastrointestinal neoplasia but remains technically demanding, with a steep learning curve posing significant training challenges, particularly in Western countries where case volumes are lower than in East Asia. This review summarizes current ESD training models including ex vivo and live animal models, simulation platforms, and traction devices. We examine learning curve evidence demonstrating that structured supervision reduces the learning curve from approximately 250 to 30-40 cases. Regional differences between Eastern and Western training paradigms are analysed. We propose a five-phase competency-based training pathway and identify priorities for future research including curriculum validation, artificial intelligence-assisted assessment, and scalable mentorship strategies.