Upper Gastrointestinal Surgery

Upper Gastrointestinal Surgery

What is the Upper Gastrointestinal Surgery?

Oesophagus and Gastric and Upper Gastrointestinal Surgery is a substantial “transferable competency”. UGI Surgery requires on one side “Knowledge” in basic sciences needed for the development of clinical, operative and endoscopical skills and on the other side specialised “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 OG Surgery covers acute and nonacute diseases and injuries and acute and elective procedures in patients of all ages. It includes the operative and non-operative management of pathological processes that affect these organs including the management of pain: prevention, diagnosis, evaluation, decision making, treatment, intensive care and rehabilitation of patients.
OG Surgery also covers the necessary knowledge and expertise leading to referral to specialised centres when this is indicated and possible. Where specialized centres are not possible because of time or geographical considerations, it defines the multi-specialty skills to carry out these interventions safely.

What is the UEMS Multidisciplinary Joint Committee of Upper GI Surgery?

The Multidisciplinary Joint committee (MJC) of “Upper GastroIntestinal Surgery – Esophagus, Cardia & Stomach Surgery” was first a working group within the UEMS Section of Surgery in 2014. The name was changed to OG (Esophagogastric) surgery in 2016 and again to Upper Gastrointestinal (Upper GI) Surgery in 2018, to reflect the work being done in collaboration with a part of the UEMS Section of Thoracic Surgery.
Upper GI is now a joint venture between esophagogastric surgeons and thoracic surgeons.

Upper Gastrointestinal Surgical activity

The Upper GI 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.

Diagnosis and treatment

The focus is on diagnosis and treatment. Diagnosis and treatment comprise all non-instrumental and instrumental techniques including flexible endoscopy, radiology, sonography, computer tomography and magnetic resonance imaging.

The UGI Surgeon must have

The Oesophagus and Gastric (OG) Surgeon must be capable of employing endoscopic techniques both for diagnostic and therapeutic purposes. They must have the opportunity to gain knowledge and experience of evolving technological methods.
The OG Surgeon must also know how to interpret all types of surgery-related radiological examinations involving the upper gastrointestinal tract.

What are the Upper GI Surgeon “Knowledge” and “Knowledge and Skills”?

The “Knowledges” and “Knowledges and Skills” required by UGI Surgery are closely related to other specialties. UGI surgeons collaborate with all other surgical specialties and a variety of non-surgical specialties like e.g. anesthesia, intensive care medicine, emergency medicine, radiology, pediatrics, gastroenterology, internal medicine, geriatrics, rehabilitation medicine. UGI Surgery is often performed in specialised centres. But, even out from a specialised centre, a UGI surgeon should possess the multi-specialty knowledges and skills to carry out required interventions safely.

The UGI 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/ robotic 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 upper 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 Upper GI surgeons expected significant knowledge

Upper Gastri-Intestinal surgeons are expected to have significant knowledge of anatomy, physiology and biochemistry as they should understand the effects of common surgical disease and injuries upon the normal structure and function of the various systems of the body.
UGI surgeons are expected to have knowledge of cell biology necessary to understand normal and disordered function of tissues and organs.
They should have an understanding of the pathogenesis of the common correctable congenital abnormalities.
Upper GI surgeons 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.
Last but not least, the Upper GI 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

Lars Bo Svendsen

Chair, MJC of UGI Surgery

Toni Lerut

Toni Lerut

Co-Chair, MJC of UGI Surgery