Here’s what therapeutic gastroscopy (EGD/OGD) training typically looks like in a structured, competency-based pathway—what you learn, how you practice, and how you get “signed off” to do therapies independently.

1) Prerequisites (before “therapeutic” work)

Most systems expect you to be competent in diagnostic upper GI endoscopy first (safe intubation, reaching D2, careful mucosal inspection, biopsies, photo-documentation, basic complication recognition). ESGE curricula for advanced procedures (like EUS/ERCP) explicitly state that upper GI endoscopy competence is a prerequisite. esge.com+1

You also need the “non-technical” foundations:

• Patient selection + consent

• Sedation/analgesia basics and monitoring

• Anticoagulant/antiplatelet management awareness

• Infection control + scope reprocessing principles

• Managing complications (bleeding, perforation, aspiration)

2) Core therapeutic skill sets you must train

Therapeutic gastroscopy usually progresses in modules:

A) Hemostasis (upper GI bleeding)

A major early therapeutic focus is stopping bleeding:

• Injection therapy

• Thermal/coagulation methods

• Mechanical clips

• Variceal band ligation (where applicable)

Many training systems use dedicated assessments for Upper GI bleed management (separate from standard diagnostic EGD). For example, JAG provides specific DOPS forms for Upper GI bleeds. thejag.org.uk

B) Foreign body / food bolus removal

Training includes safe retrieval techniques and risk triage (sharp objects, batteries, obstruction).

C) Stricture management: dilation + stents

• Balloon/bougie dilation technique

• Recognition of high-risk strictures and perforation risk

• Stent indications/complications
  JAG also maintains DOPS for dilation/stents. thejag.org.uk

D) Enteral access (PEG) in appropriate settings

PEG placement requires its own competency steps and assessment; JAG provides a PEG DOPS. thejag.org.uk

E) Resection skills (more advanced)

• Polypectomy, EMR, and (in specialist centers) ESD
  This is typically later, often after strong diagnostic skills and hemostasis competence.

3) How training is delivered (what “good” looks like)

A modern program combines:

• Simulation / models first (scope handling, clip deployment, injection, banding mechanics)

• Supervised patient cases with graded autonomy

• Video review + case-based teaching
  ESGE’s training guidance emphasizes structured curricula and continuous educational activities rather than “just doing cases.” esge.com+1

4) Logging and competency assessment (how you get signed off)

Training is increasingly competency-based, using structured assessment tools—not just a case count.

Commonly used assessment frameworks:

• ASGE ACE tools for EGD performance assessment (formative tracking of skill development). PubMed+1

• DOPS (Direct Observation of Procedural Skills) used widely in the UK/JAG system (formative + summative pathways). thejag.org.uk+1

Case numbers: used as “minimum exposure,” not a guarantee

Examples of published thresholds used before assessment:

• ASGE has historically cited ~130 EGDs before competency can be assessed (emphasis: minimum; many need more). www.asge.org

• JAG’s gastroscopy pathway has used a minimum lifetime count of 250 OGD procedures before eligibility/assessment in its pathway updates and consensus standards. thejag.org.uk+1

For therapeutic privileges, many hospitals then require documented competence in specific therapies (e.g., bleeding control, PEG, dilation) plus proctoring/credentialing frameworks. www.asge.org+1

5) A practical training roadmap (simple checklist)

1. Master diagnostic EGD (D2 intubation, systematic inspection, biopsy, reporting).

2. Start hemostasis module early (simulation → supervised real bleeds → formal assessment).

3. Add foreign body/food bolus and dilation under direct supervision.

4. Add PEG only after you’re reliable with anatomy, transillumination principles, and complication management.

5. Use structured tools each week (ACE/DOPS) + maintain a logbook with outcomes and complications.

6. After sign-off, do a mentored transition period (proctoring/second operator available for complex therapy).

If you tell me your background (medical student vs resident vs GI fellow vs surgeon) and your country/training system, I can tailor this into a week-by-week skills plan and a competency checklist matched to the typical credentialing pathway used in that setting.