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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2026; 18(2): 113502
Published online Feb 16, 2026. doi: 10.4253/wjge.v18.i2.113502
Published online Feb 16, 2026. doi: 10.4253/wjge.v18.i2.113502
Mastering gastric endoscopic submucosal dissection: A learning curve analysis of over 100 consecutive cases performed by Western endoscopist
Josué Aliaga Ramos, Service of Gastroenterology, Hospital José Agurto Tello-Chosica, 150118, Lima 15, Peru
Josué Aliaga Ramos, Service of Gastroenterology, Clinica Madre Zoraida, 150118, Lima 15, Peru
Vitor Nunes Arantes, Endoscopy Unit, Alfa Institute of Gastroenterology, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Vitor Nunes Arantes, Endoscopy Unit, Hospital Mater Dei Contorno, Belo Horizonte 30130-100, Minas Gerais, Brazil
Co-first authors: Josué Aliaga Ramos and Vitor Nunes Arantes.
Author contributions: Aliaga Ramos J and Arantes VN designed this study, performed the research and project administration, wrote the original draft and final draft, and made equal contributions to this manuscript as co-first authors. All authors approved the final manuscript.
Institutional review board statement: This study took place in an endoscopic referral center in Brazil, and approval by the Institutional Review Board, obtained on May 6, 2020.
Informed consent statement: The authors declare that this study entailed a retrospective evaluation of the learning curve in gastric endoscopic submucosal dissection and was conducted in accordance with the Declaration of Helsinki. The analysis was confined to the statistical assessment across four defined chronological periods. Therefore, specific informed consent was not required for the preparation of this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Josué Aliaga Ramos, MD, Service of Gastroenterology, Hospital José Agurto Tello-Chosica, 229 Walter Stubbs Street, 150118, Lima 15, Peru.
Received: August 27, 2025
Revised: September 26, 2025
Accepted: December 5, 2025
Published online: February 16, 2026
Processing time: 161 Days and 10.4 Hours
Revised: September 26, 2025
Accepted: December 5, 2025
Published online: February 16, 2026
Processing time: 161 Days and 10.4 Hours
Core Tip
Core Tip: Currently, scientific evidence on the learning curve in gastric endoscopic submucosal dissection (ESD) is limited, and most of the available data comes from Asian countries. This lack of scientific evidence represents a significant barrier, especially given the progressive increase in the early diagnosis of gastric cancer in Western regions and the growing interest in effective and minimally invasive endoscopic therapeutic strategies. The learning curve in gastric ESD is feasible, safe, and effective in Western countries, provided that intensive training and adequate progressive case selection are in place. According to our case series, after 112 ESD procedures, consolidated technical mastery is achieved.