DEFINITION OF
UGI (UPPER GI) SURGERY

UGI 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 UGI 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 specialized 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.

UGI Surgery (upper GI surgeons/thoracic surgeons) cooperates with other surgical specialties, e.g, anesthesia, intensive care, emergency medicine, radiology, pediatrics, internal medicine, medical gastroenterologists,  geriatrics, rehabilitation medicine and pharmacy in the management of patients.

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 UGI 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 comprises all non-instrumental and instrumental techniques including flexible endoscopy, radiology, sonography, computer tomography and magnetic resonance imaging.

The Upper GI Surgeon must have

The UGI 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 UGI Surgeon must be also capable of interpreting all types of surgery-related radiological examinations involving the upper gastrointestinal tract.

What are the Upper GI Surgeon “Knowledge and Skills”

The UGI surgeon must have acquired and must maintain specialized "Knowledges" and "Knowledges and Skills" (precisely defined in an 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 robotic, 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 "Knowledges" and "Knowledges and Skills" required by UGI Surgery are closely related to other specialties and UGI surgeons (upper GI surgeons/thoracic surgeons) collaborate with all other surgical specialties and a variety of non-surgical specialties like e.g., anesthesia, intensive care medicine, emergency medicine, radiology,  paediatrics, internal medicine, geriatrics, rehabilitation medicine, medical gastroenterologists aso.

UGI Surgery is often performed in specialized centers, but an UGI 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, UGI 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 OG surgeon must be trained in the economics of health care, in the assessment and practice 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, DMSci
Chairman, MJC Upper GI Surgery

Toni Lerut, MD, PhD
Co-chairman, MJC Upper GI Surgery (thorax)

Philippe Nafteux,MD,PhD
Chairman of the UEMS Board  of Upper GI  Surgery