ECS Surgery (OesophagoGastric)

The Division of "ECS - Esophagus, Cardia & Stomach Surgery" was founded within the Section of Surgery in 2014.

DEFINITION OF ECS (ESOPHAGUS, CARDIA, STOMACH) SURGERY


ECS Surgery is a substantial "transferable competency" which requires the acquisition of "Knowledges" in basic sciences required in the development of clinical, operative and endoscopical skills as well as specialized "Knowledges and Skills" in managing congenital and acquired diseases and injuries of the upper part of the gastrointestinal tract, which are treated by operative and other interventions.
The "transferable competency" of ECS Surgery covers acute and nonacute diseases and injuries and acute and elective procedures in patients of all ages.
It provides for the operative and non-operative management, i.e. prevention, diagnosis, evaluation, decision making, treatment, intensive care and rehabilitation of patients with pathological processes that affect these organs including the management of pain.
It also involves the necessary knowledge and expertise leading to referral to specialised centers when this is indicated and possible, and where this is not possible because of time or geographical considerations, to possess the multi-specialty skills to carry out these interventions safely.


ECS Surgery cooperates with other surgical specialties, e.g. anesthesia, intensive care, emergency medicine, radiology, pediatrics, internal medicine, geriatrics, rehabilitation medicine and pharmacy in the management of patients.


The ECS surgeon must have acquired and must maintain specialised "Knowledges" and "Knowledges and Skills" (precisely defined in this additional catalogue) relating to the diagnosis, preoperative, operative and postoperative management in the following areas of primary responsibility:

  • Abdominal wall and abdominal organs,
  • Alimentary tract,
  • Thoracic wall and organs, including vascular, congenital and oncological disorders, particularly tumors and functional disorders of the upper GI alimentary tract.
  • Minimal invasive surgery, especially laparoscopic and thoracoscopic procedures
  • Diaphragmatic surgery, including diagnosis and surgery for hiatal hernia and reflux disorders
  • Bariatric surgery, including diagnosis, indications and procedures
  • Surgical oncology, including coordinated multidisciplinary management of the cancer patient,
  • Comprehensive management of trauma to the upper alimentary tract,
  • Care of critically ill patients with underlying conditions including coordinated multidisciplinary management,
  • Flexible endoscopy of alimentary tract, diagnostic and therapeutic, as well as advanced therapeutic procedures
  • Methods for gastrointestinal function diagnosis, especially manometry and pH-metry
  • Diagnostic and interventional radiology including sonography

The focus is on diagnosis and treatment. Diagnosis and treatment comprises all non-instrumental and instrumental techniques including flexible endoscopy, radiology, sonography, computer tomography and magnetic resonance imaging.
The ECS Surgeon must be capable of employing endoscopic techniques both for diagnostic and therapeutic purposes and must have the opportunity to gain knowledge and experience of evolving technological methods.
The ECS Surgeon must be also capable of interpreting all types of surgery-related radiological examinations involving the upper gastrointestinal tract.
The ECS Surgical activity covers the pre-, peri- and postoperative period and follow-up of patients. The specialty also includes individual and general preventive activities, rehabilitation, palliation and management of pain, especially in oncologic patients.
The specialty particularly focuses on managing diseases and injuries of the esophagus, GI junction and stomach, diaphragm and conditions related to morbid obesity.

The "Knowledges" and "Knowledges and Skills" required by ECS Surgery are closely related to other specialities and ECS surgeons collaborate with all other surgical specialities and a variety of non-surgical specialties like e.g. anaestesia, intensive care medicine, emergency medicine, radiology, paediatrics, internal medicine, geriatrics, rehabilitation medicine.
ECS Surgery is often performed in specialised centers, but a ECS surgeon should be able to - when this is indicated and possible, and where it is not possible because of time or geographical considerations, - to possess the multi-specialty knowledges and skills to carry out required interventions safely.

Additionally, ECS surgeons are expected to have significant knowledge of anatomy, physiology and biochemistry which enable them to understand the effects of common surgical disease and injuries upon the normal structure and function of the various systems of the body.
They are expected to have knowledge of cell biology which enable them to understand normal and disordered function of tissues and organs.
They should have an understanding of the pathogenesis of the common correctable congenital abnormalities.
They are expected to know the actions and toxic effects of drugs commonly used in perioperative and intraoperative care and in the management of critically ill surgical patients.

They must also have an understanding of general pathology including the principles of immunology and microbiology in relation to surgical practice.
The ECS surgeon must be trained in the economics of health care, in the assessment of research methods and scientific publications and be given the option of research in a clinical and relevant field of further training in another related specialty.


Lars Bo Svendsen                                                Wolfgang Feil

Chairman, Division of ECS Surgery                     President of the European Board of Surgery