SYLLABUS

The Endoscopy & Gastrointestinal Functional Diagnostics (EndoGI-FD) syllabus comprehensively describes "Theoretical Knowledge" and "Practical & Clinical Skills" (= basis for an individual "Log-book") mandatory for the qualification as F.E.B.S./EndoGI-FD.

The syllabus is at that time is not a complete curriculum that gives a structured educational plan but provides a crude orientation and a framework around which preparation for the qualification as F.E.B.S./EndoGI-FD can be structured.

The syllabus should not be viewed as static but will be continuously revised and updated by the members of the committee. It is noted, that research and changes in medicine may lead to significant changes in theory and clinical practice and by that will influence the content of the syllabus. New topics will be introduced and obsolete topics may be deleted. The candidates are expected to update their level according to the recent surgical practice and scientific literature.

To achieve the qualification as F.E.B.S./EndoGI-FD "Theoretical Knowledge" have to be documented and provided for Eligibility and are assessed by Examination.

"Clinical & Practical Skills" have to be documented and proved in the log-book for Eligibility and may be additionally assessed by examination. For pragmatical reasons the individual log-books are scrutinised in the Eligibility process taking into consideration the various national requirements and local situations.

Theoretical Knowledge

 Theoretical Knowledge

To achieve the qualification as F.E.B.S./EndoGI-FD "Theoretical Knowledge" have to be documented and provided for Eligibility and are assessed by Examination.

General Knowledge

Preoperative Management
  • Physical examination
  • Tests of respiratory, cardiac, renal and endocrine function
  • Electrocardiography and interpretation
  • Management of associated medical conditions, eg. diabetes, respiratory disease, cardiovascular disease, malnutrition, anaemia, jaundice, steroid, anticoagulant, immunosupressant and other drug therapy, and drug treatment for psychiatric disorders
  • Patient information and documentation of informed consent
  • Prophylaxis of thromboembolic disease
  • Assessment of fitness for anaesthesia and surgery
  • Premedication and sedation
Intraoperative Care
  • Patient positioning
  • Prevention of nerve and other injuries in the anaesthetised patient
  • Principles of general and regional anaesthesia
  • Care and monitoring of the anaesthetised patient
Postoperative Management
  • Pain control
  • Post-operative monitoring
  • Post-operative complications
  • Prevention, recognition and management of complications
  • Techniques of venous access
  • Assessment and maintenance of fluid and electrolyte balance
  • Blood transfusion-indications, hazards, complications, plasma substitutes
  • Respiratory failure-recognition and treatment
  • Nutritional support-indications, techniques, total parenteral nutrition

Surgical Sepsis and its Prevention

  • Hospital hygiene
  • Aseptic techniques
  • Sterilisation
  • Principles of asepsis and antisepsis
  • Surgically important micro-organisms
  • The sources of surgical infection-prevention and control
  • Pathophysiology of the body’s response to infection
  • Septic Shock
  • Antibiotic prophylaxis and therapy of infections
  • Surgery in hepatitis and HIV carriers-special precautions

Basic Surgical Technique and Technology

  • Patients' positioning
  • Dressings
  • Principles and techniques of biopsy and cytological sampling
  • Modalities of tissue probe sampling for frozen section and paraffine histology, cytology and bacteriology
  • Emergency surgery techniques
  • Disorders of coagulation and haemostasis
  • Diathermy-principles and precautions, alternative energy sources (e.g. Harmonic)
  • Lasers-principles and precautions
  • Explosion hazards relating to general anaesthesia and endoscopic surgery

Radiology

  • Principles of diagnostic radiography, Sonography, Computed Tomography and Magnetic Resonance Imaging and related techniques
  • Principles and handling of contrast media
  • Diagnostic and therapeutic interventional radiological methods
  • Interventional radiological implantation of prostheses and stents into vessels, organs and other structures
  • Security measures in Radiology

Evaluation & Quality

  • Decision-making in surgery
  • Clinical audit
  • Statistics and computing in surgery
  • Documentation
  • Principles of research and design and analysis of clinical trials
  • Critical evaluation of innovations-technical and pharmaceutical
  • Health Service management and economic aspects of surgical care
  • Medical/legal ethics and medico-legal aspects of surgery
  • Psychological effects of surgery and bereavement
  • Rehabilitation
  • Screening programmes
  • Principles and pharmacology of intravenous drug delivery
  • Quality control and quality management
  • CIRS (Critical Incident Reporting System)
  • Implementation of clinical studies
  • Legal aspects
  • Communication with patients, relatives and colleagues

Technique of Endoscopy & Endoscopic Procedures

  • Prepare patient for procedure (e.g. informed consent, bowel preparation, management of anticoagulants and antiplatelet medications, management of cardiac rhythm devices, periprocedural antibiotics)
  • Basic understanding of GI diseases and endoscopic GI anatomy
  • Basic understanding of flexible endoscope function (characteristics of endoscopes: e.g. fiberoptic components, videoendoscopic components, image capture, channels, tip control)
  • Principles of knowledge about the equipment
  • Knowledge of the required equipment for endoscopic interventions
  • Principles of hygiene in endoscopy: care, cleaning, correct storage
  • Handling of endoscopes and hygienic measures
  • Indications and contraindications of flexible endoscopic procedures, periprocedural patient management
  • Appropriate and safe use of endoscopy (e.g. indications, contraindications, recognition and management of normal and abnormal findings)
  • Principles of sedation/analgesia
  • Knowledge and skills in sedation/analgesia
  • Image differentiation of normal/abnormal pathology
  • Recognition and management of complications
  • Principles of the oncologic preconditions for endoscopic interventions
  • Knowledge of pathology related to endoscopic findings and interventions
  • Knowledge of evidence-based endoscopic pre- and aftercare examinations
  • Knowledge of radiology (x-ray, postinterventional check of the result)
  • Knowledge of pathophysiology of motility and its disorders in the upper and lower gastrointestines
  • Knowledge of endo-ultrasonic diagnosis/procedures
  • Knowledge of the surgical treatment of lesions and complications caused endoscopically (acute surgery: open and laparoscopic)
Procedures
  • Flexible diagnostic and interventional esophago-gastroduodenoscopy
  • Flexible diagnostic and interventional coloscopy
  • Flexible diagnostic and interventional bronchoscopy
  • Endoscopic Retrograde Cholangiopancreatography (ERCP) (e.g. indications, preparation, performance of ERCP, complications, pathology Recognition)
  • Flexible diagnostic and interventional endosonography
  • Interventional endoscopy (e.g. dilatation, stenting, polypectomy, mucosectomy, RF treatment)
  • Endoscopical ultrasonography with advanced procedures, including bioposies
  • Therapeutic endoscopic interventions (e.g. polypectomy, dilatation)
  • Sclerotherapy and banding of esophageal varices
  • Treatment of gastrointestinal bleeding sites (injection, clipping. electrofulgeration)
  • Hemostasis (non-thermal techniques, thermal techniques)
  • Management of bleeding (e.g. variceal, nonvariceal, neoplasms)
  • Endoscopic mucosectomy (EMR, ESD)
  • Tissue acquisition using biopsy or polypectomy
  • Tissue Removal  (e.g. resective techniques, sampling techniques, ablative techniques)
  • Intraoperative endoscopy, ICU endoscopy, continued endoscopic experience
  • Management of strictures (e.g. upper GI, colonic)
  • Foreign Body Removal
  • Placement of a percutaneous endoscopic gastrostomy (PEG)
  • Transgastric endoscopic interventions (e.g. necrosectomy)
  • Choledochoscopy
  • Luminal dilation techniques
  • An understanding of the indications and contraindications for performing upper and lower endoscopy
  • Knowledge of oncologic principles regarding endoscopic interventions
  • Accurate recognition and management of normal and abnormal findings in the GI tract
  • Recognition and management of complications from performing GI endoscopy
  • Safe performance of upper and lower endoscopy including complete navigation of the esophagus, stomach, proximal duodenum, and colon
  • Mucosal inspection and recognition of lesions that may require surgery
  • Management of periprocedural bleeding
  • Sedation and analgesia
  • Simulation or clinical tutorial exposure with an emphasis on basic scope manipulation including one-handed wheel deflection, control of suction, irrigation, and insufflation, and passage of instruments through the working channel
  • Simulation or clinical exposure with demonstration of proper endoscope setup and function, troubleshooting of common problems, and a continued emphasis on basic scope manipulation

Esophagus

Conditions
  • Zenker’s diverticulum
  • Epiphrenic diverticulum
  • Gastroesophageal reflux disease and Barrett’s esophagus
  • Hiatal hernia
  • Strictures, dysphagia
  • Schatzki’s ring
  • Motility Disorders other than achalasia (e.g. diffuse esophageal spasm, hypermotility, hypomotility)
  • Achalasia
  • Diffuse esophageal spasm
  • Nutcracker esophagus
  • Foreign bodies
  • Mallory-Weiss syndrome
  • Spontaneous esophageal perforation
  • Iatrogenic esophageal perforation
  • Chemical burns
  • Caustic ingestion
  • Scleroderma connective tissue disorders
  • Benign neoplasms
  • Malignant esophageal neoplasms (e.g. diagnosis, epidemiology, staging/grading, therapy modalities, palliation)
  • GERD/Barrett’s Esophagus Module (e.g. pertinent anatomy/histology/physiology, epidemiology, prevention, diagnosis, concepts/indications for surgical or endoscopic treatment)
  • Hiatal hernia (diagnosis, staging/grading, concepts for surgical treatment, nonsurgical Treatment, alternative and adjuvant treatment, outcomes assessment)
  • Benign esophageal neoplasms e.g. leiomyoma fibrolipoma, fibrovascular polyps)
Procedures
  • Taking biopsies, tumor localisation
  • Excision of lesions (polypectomy, mucosectomy-EMR-ESD)
  • Hemostasis techniques (e.g. hemoclipps, injection therapy, rubber band legation, laser)
  • Endoscopic prosthesis/stenting (including complication management in case of anastomotic leakage)
  • Dilatation (and bougienage)
  • Endosonographic tumor staging
  • Transesophageal punctions (e.g. tumors, lymph nodes)

Stomach & Duodenum

Conditions
  • Gastric and duodenal ulcer (diagnosis, concepts for surgical and nonsurgical treatment, including alternative and adjuvant treatments, outcomes assessment)
  • Complications of peptic ulcer disease (e.g. bleeding, perforation, obstruction)
  • Gastric and duodenal benign and malignant neoplasms (e.g. polyps, carcinoma, NET, GIST, lymphoma)
  • Upside down stomach
  • Upper gastrointestinal bleeding
  • Duodenal ulcer with bleeding, perforation or obstruction
  • Gastric ulcer with bleeding, perforation or obstruction
  • Gastritis
  • Morbid obesity
  • Foreign bodies and bezoars  
  • Gastroparesis
  • Postgastrectomy syndromes
Procedures
  • Taking biopsies
  • Excision of lesions (polypectomy, mucosectomy-EMR-ESD)
  • Hemostasis (hemoclipps, injection therapy, rubber band legation, laser)
  • Application of PEG, JET-PEG
  • Endoscopic prosthesis/stenting (including complication management in case of anastomotic leakage)
  • Dilatation (and bougienage)
  • Endosonographic tumor staging
  • Transgastric punctions and drainage (e.g. tumors, necrosectomy)

Hepatobiliary system

Conditions
  • Choledocholithiasis
  • Benign biliary strictures
  • Malignant biliary tumors
  • Biliary leakage (e.g. after surgery or trauma)
  • Cholangitis
  • Biliary pancreatitis
  • Complications after biliary surgery
  • Complications after pancreatic surgery
  • Sphincter Oddi Dysfunction (SOD)
Procedures
  • Taking biopsies/brush-cytology
  • Endoscopic prosthesis/stenting
  • Dilatation
  • Extraction of concrements by means of ERCP
  • Drainage of the biliary and pancreatic ducts
  • Endoscopic intervention on the papilla Vateri

Small bowel

Conditions
  • Bleeding sites
  • Small Intestine neoplasms (e.g. polyps, GIST, NET, adenocarcinoma)
  • Crohn’s Disease
  • Anastomotic complications or rejection after pancreas transplantion
Procedures
  • Enteroscopy (including interventional techniques as endoscopic hemostasis, dilatation, stenting)
  • Capsule endoscopy (indications and limitations)

Large bowel

Conditions
  • Polyps
  • Benign neoplasmas
  • Malignant neoplasmas
  • Diverticulitis/Colitis
  • Cancer Module
  • Lower GI-Bleeding
  • C-Difficile Associated Diarrhea
  • Crohn’s Disease
  • Ulcerative Colitis
  • Ischemic Colitis
  • Appendiceal Neoplasms
Procedures
  • Taking biopsies
  • Excision of lesions (polypectomy, mucosectomy-EMR-ESD)
  • Colonoscopic gas evacuation
  • Hemostasis (hemoclipps, injection therapiy, rubber band legation, laser)
  • Endoscopic prosthesis/stenting
  • Dilatation (and bougienage)
  • Diagnostic (and interventional) endosonographic procedures

Gastrointestinal Functional Diagnostics

  • Diagnosis of gastroesophageal reflux (e.g. pH-metry)
  • Diagnosis of esophageal and gastric motility disorders (e.g. manometry)
  • 24-hour-ph measurement
  • Esophageal manometry
  • Anal manometry
  • Measurement of the gastroesophageal reflux
  • Measurement of the gastric bolus passage

This list of activities shows that the surgeon working in endoscopy and gastointestinal functional diagnostics needs close interdisciplinary cooperation with pathology and hygiene at the department.

Christoph Profanter
Foundation Chairperson, European Board of Endo GI-FD

Wolfgang Feil
President of the European Board of Surgery