Training in diagnostic and interventional endoscopic ultrasound: a state-of-the-art review

INTRODUCTION: Endoscopic ultrasound (EUS) has progressed from a primarily diagnostic modality to an essential diagnostic and therapeutic platform. The rapid expansion of EUS indications, particularly in advanced biliopancreatic interventions, has exposed important limitations in traditional training paradigms. AREAS COVERED: This state-of-the-art review analyzes current approaches to training in diagnostic and interventional EUS, focusing on their strengths and limitations. We examine the declining relevance of fixed procedural volume thresholds and the growing adoption of competency-based educational frameworks supported by validated assessment tools. Key elements include structured curricula, performance assessment, simulation-based training, stepwise acquisition of interventional skills, and complication management. Emerging applications of artificial intelligence are also reviewed. The literature was identified through targeted searches of major biomedical databases (PubMed/MEDLINE, Embase, and Scopus) covering the period from January 2000 to January 2026, along with relevant international guideline documents. EXPERT OPINION: Competency-based training should be considered the foundation of modern EUS education. Future models will increasingly rely on simulation, artificial intelligence-driven feedback, and longitudinal performance monitoring to enhance objectivity and reproducibility. International harmonization of training standards remains essential.