Endoscopic submucosal dissection (ESD) is a technically demanding procedure with a steep learning curve. The European Society of Gastrointestinal Endoscopy (ESGE), as most international societies, recommends training on animal models prior to performing ESD in humans, and guidelines emphasize the importance of structured programs to achieve competency.

In this context, we evaluated the feasibility of ex-vivo animal model training through unsupervised procedures, in addition to participation in such dedicated curriculum (SFED program, including both in-vivo and ex-vivo training).

Performance was assessed over 14 unsupervised ex-vivo procedures before and 14 procedures after a one-week supervised intensive training course in a specialized facility, with the aim of determining whether there was a measurable improvement in outcomes.

The mean area of resected ex-vivo specimens prior to the course was 261 mm² (range 33–777), compared with 240 mm² (range 80–667) after the course, with no statistically significant difference between groups. The mean duration of the procedures was significantly reduced, from 31 minutes pre-course (range 17–54; SD 10.8) to 16.5 minutes post-course (range 12–24; SD 3.2). Six perforations occurred before the course, representing 43% of procedures (2 complete and 4 incomplete perforations), whereas no perforations were observed after the course. Two initial procedures were excluded from the analysis due to extensive perforations that made completion of the dissection impossible.

When dissection characteristics of the ex-vivo specimens were analyzed, the mean dissection speed increased from 8.7 mm²/min (range 1.3–15.3; SD 5.2) before the course to 14.2 mm²/min (range 3.9–44.5; SD 11.2) after the course, corresponding to a 62.6% improvement in speed. This improvement in efficiency was achieved without compromising specimen size and was associated with a marked reduction in perforation rate.

A one-week intensive supervised training program significantly increased dissection speed on an ex-vivo animal model and markedly reduced the perforation rate during unsupervised ESD procedures. These findings support the value of structured, short-term intensive training within dedicated curricula to enhance both efficiency and safety in the early phase of ESD skill acquisition.