Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is among the most complex procedures in digestive endoscopy, associated with high technical demands and risk of complications. While proficiency is essential for safe and effective clinical practice, training programs remain highly variable across Europe. To address these inconsistencies, the European Society of Gastrointestinal Endoscopy (ESGE) has published a structured core curriculum that outlines minimum standards for ERCP training. However, it is unclear to what extent these recommendations are being implemented in Italy. This study aims at exploring the current ERCP training practices among young Italian endoscopists.

An anonymous e-survey was developed and distributed via Google Forms to all members of the Italian Association of Young Gastroenterologists and Endoscopists (AGGEI) since October 2024. The questionnaire was designed to assess demographics, ERCP training characteristics, procedural exposure, perceived competence, feedback and assessment methods, and overall satisfaction. Responses were collected up to January 2025. Inclusion criteria were age under 40 and less than 5 years of ERCP training experience. Descriptive statistics were calculated, and a multivariable linear regression analysis was performed to identify factors independently associated with perceived training quality.

A total of 39 out of 904 young Italian endoscopists completed the survey (response rate: 4.3%). Most were male (69%) and aged 30–34 years (56%). The majority (87%) began ERCP training during residency, typically in the last year, and 67% worked in high-volume centres (≥200 ERCPs/year). Training practices varied considerably. While 67% had access to a dedicated ERCP mentor and 74% received integrated EUS training, only 3% reported using simulation-based tools. Regular feedback from mentors (daily or weekly) was reported by 62%, yet only 4 (10.3%) had completed a structured core curriculum. Participants expressed higher confidence in cognitive skills (mean 3.5/5, 79.5% ≥3) than in motor skills (mean 2.9/5, 61.5% ≥3). Most trainees required supervision for core therapeutic manoeuvres, with only 43.6% performing ERCPs at least partially independently; the majority (53.8%) required constant supervision or served only as assistants. Perceived training quality was rated as "Excellent" by 13%, "Very Good" by 18%, "Good" by 33%, "Fair" by 28%, and "Poor" by 8%. In multivariable regression, two factors were significantly associated with higher perceived quality: motor skill confidence (β = 0.46, p = 0.004) and inclusion of EUS training (β = 0.81, p = 0.044). Mentor availability, simulator use, and feedback frequency were not significantly associated with perceived quality.

These early findings indicate substantial variability in ERCP training practices among young Italian endoscopists, with limited adherence to the ESGE curriculum recommendations. The inconsistent presence of mentors, minimal use of simulation tools, and unstructured assessment frameworks may hinder the development of essential competencies. As ESGE emphasises a structured, competency-based approach, including simulation and summative assessment, efforts should be made to align national training programs with these standards. Greater adoption of the ESGE core curriculum could help standardise ERCP education, promote procedural safety, and ensure a more equitable learning experience across training centres in Italy.