MCh Surgical Gastroenterology or Master of Chirurgiae in Surgical Gastroenterology also known as MCh in Surgical Gastroenterology is a super specialty level course for doctors in India that is done by them after completion of their postgraduate medical degree course. The duration of this super specialty course is 3 years, and it focuses on the study of diseases and surgery of the Gastrointestinal system. This includes the esophagus, stomach, small intestine, large intestine, and rectum. It also includes the liver, gallbladder, and pancreas.
The course is a full-time course pursued at various recognized medical colleges across the country. Some of the top medical colleges offering this course include Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, Indira Gandhi Institute of Medical Sciences, Sheikhupura, Patna, Bihar, Postgraduate Institute of Medical Education & Research, Chandigarh many more.
Admission to this course is done through the NEET-SS Entrance exam conducted by the National Board of Examinations, followed by counseling based on the scores of the exam that is conducted by DGHS/MCC/State Authorities.
The fee for pursuing MCh (Surgical Gastroenterology) varies from college to college and may range from Rs.1,500 to Rs 6,04,000 in a government college and for private colleges from Rs.15,00,000 to Rs.29,00,000 per year.
After completion of their respective course, doctors can either join the job market or can pursue certificate courses and Fellowship programs recognized by NMC and NBE. Candidates can take reputed jobs at positions as Senior residents, Consultants, etc. with an approximate salary range of Rs 35 lakhs to Rs. 50 lakhs per annum.
What is MCh in Surgical Gastroenterology?
Master of Chirurgiae in Surgical Gastroenterology, also known as MCh (Surgical Gastroenterology) or MCh in (Surgical Gastroenterology) is a three-year super specialty program that candidates can pursue after completing a postgraduate degree.
Surgical Gastroenterology is the branch of medical science dealing with the study of diseases and surgery of the Gastrointestinal system. This includes the esophagus, stomach, small intestine, large intestine, and rectum. It also includes the liver, gallbladder, and pancreas.
National Medical Commission (NMC), the apex medical regulator, has released a Guidelines for Competency-Based Postgraduate Training Programme for MCh in Surgical Gastroenterology.
The Competency-Based Postgraduate Training Programme governs the education and training of MChs in Surgical Gastroenterology.
The postgraduate students must gain ample knowledge and experience in the diagnosis, and treatment of patients with acute, serious, and life-threatening medical and surgical diseases.
PG education intends to create specialists who can contribute to high-quality health care and advances in science through research and training.
The required training done by a postgraduate specialist in the field of Surgical Gastroenterology would help the specialist to recognize the health needs of the community. The student should be competent to handle medical problems effectively and should be aware of the recent advances in their specialty.
The candidate is also expected to know the principles of research methodology and modes of the consulting library. The candidate should regularly attend conferences, workshops, and CMEs to upgrade her/ his knowledge.
Course Highlights
Here are some of the course highlights of MCh in Surgical Gastroenterology
| Name of Course | MCh in Surgical Gastroenterology |
| Level | Doctorate |
| Duration of Course | Three years |
| Course Mode | Full Time |
| Minimum Academic Requirement | Candidates must have a postgraduate medical Degree in MS/DNB (General Surgery) obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE, this feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website. |
| Admission Process / Entrance Process / Entrance Modalities | Entrance Exam (NEET-SS) INI CET for various AIIMS, PGIMER Chandigarh, JIPMER Puducherry, NIMHANS Bengaluru Counseling by DGHS/MCC/State Authorities |
| Course Fees | 1,500 to Rs 6,04,000 per year in Government colleges Rs.15,00,000 to Rs.29,00,000 per year in Private colleges |
| Average Salary | Rs 35 lakhs to Rs.50 lakhs per annum |
Eligibility Criteria
The eligibility criteria for MCh in Surgical Gastroenterology are defined as the set of rules or minimum prerequisites that aspirants must meet to be eligible for admission, which include:
| Name of Super Specialty course | Course Type | Prior Eligibility Requirement |
| Surgical Gastroenterology | MCh | MS/DNB (General Surgery) |
Note:
· The feeder qualification for MCh Surgical Gastroenterology is defined by the NBE and is subject to changes by the NBE.
· The feeder qualification mentioned here is as of 2022.
· For any changes, please refer to the NBE website.
- The prior entry qualifications shall be strictly by Post Graduate Medical Education Regulations, 2000, and its amendments notified by the NMC and any clarification issued from NMC in this regard.
- The candidate must have obtained permanent registration with any State Medical Council to be eligible for admission.
- The medical college's recognition cut-off dates for the Postgraduate Degree courses shall be as prescribed by the Medical Council of India (now NMC).
Admission Process
The admission process contains a few steps to be followed in order by the candidates for admission to MCh in Surgical Gastroenterology. Candidates can view the complete admission process for MCh in Surgical Gastroenterology mentioned below:
- The NEET-SS or National Eligibility Entrance Test for Super specialty courses is a national-level master's level examination conducted by the NBE for admission to DM/MCh/DrNB Courses.
- Qualifying Criteria-Candidates placed at the 50th percentile or above shall be declared as qualified in the NEET-SS in their respective specialty.
- The following Medical institutions are not covered under centralized admissions for DM/MCh courses through NEET-SS:
1. AIIMS, New Delhi, and other AIIMS.
2. PGIMER, Chandigarh
3. JIPMER, Puducherry
4. NIMHANS, Bengaluru
- Candidates from all eligible feeder specialty subjects shall be required to appear in the question paper of the respective group if they are willing to opt for a super specialty course in any of the super specialty courses covered in that group.
- A candidate can opt for appearing in the question papers of as many groups for which his/her Postgraduate specialty qualification is an eligible feeder qualification.
- By appearing in the question paper of a group and on qualifying for the examination, a candidate shall be eligible to exercise his/her choices in the counseling only for those super specialty subjects covered in the said group for which his/ her broad specialty is an eligible feeder qualification.
Fees Structure
The fee structure for MCh in Surgical Gastroenterology varies from college to college. The fee is generally less for Government Institutes and more for private institutes. The average fee structure for MCh in Surgical Gastroenterology may range from Rs.1,500 to Rs 6,04,000 per year in government colleges and for private colleges from Rs.15,00,000 to Rs.29,00,000 per year.
Colleges offering MCh in Surgical Gastroenterology
Various medical colleges across India offer courses for pursuing MCh in (Surgical Gastroenterology).
As per National Medical Commission (NMC) website, the following medical colleges are offering MCh in (Surgical Gastroenterology) courses for the academic year 2022-23.
| Sl.No. | Course Name | State | Name and Address of Medical College / Medical Institution | Annual Intake (Seats) |
| 1 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Andhra Pradesh | Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati | 4 |
| 2 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Andhra Pradesh | Narayana Medical College, Nellore | 2 |
| 3 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Bihar | Indira Gandhi Institute of Medical Sciences, Sheikhupura, Patna | 3 |
| 4 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Chandigarh | Postgraduate Institute of Medical Education & Research, Chandigarh | |
| 5 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Delhi | G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi | 3 |
| 6 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Delhi | All India Institute of Medical Sciences, New Delhi | 15 |
| 7 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Gujarat | Smt. N.H.L.Municipal Medical College, Ahmedabad | 1 |
| 8 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Jammu & Kashmir | Sher-I-Kashmir Instt. Of Medical Sciences, Srinagar | 2 |
| 9 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Karnataka | Karnataka Institute of Medical Sciences, Hubballi | 2 |
| 10 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Karnataka | Bangalore Medical College and Research Institute, Bangalore | 2 |
| 11 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Kerala | Medical College, Thiruvananthapuram | 2 |
| 12 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Kerala | Amrita School of Medicine, Elamkara, Kochi | 4 |
| 13 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Maharashtra | Seth GS Medical College, and KEM Hospital, Mumbai | 2 |
| 14 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Orissa | Instt. Of Medical Sciences & SUM Hospital, Bhubaneswar | 2 |
| 15 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Pondicherry | Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry | 3 |
| 16 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Rajasthan | All India Institute of Medical Sciences, Jodhpur | 2 |
| 17 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Rajasthan | National Institute of Medical Science & Research, Jaipur | 3 |
| 18 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Rajasthan | Mahatma Gandhi Medical College and Hospital, Sitapur, Jaipur | 2 |
| 19 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Tamil Nadu | Stanley Medical College, Chennai | 7 |
| 20 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Tamil Nadu | Madras Medical College, Chennai | 6 |
| 21 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Tamil Nadu | Dhanalakshmi Srinivasan Medical College and Hospital,Perambalur | 2 |
| 22 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Tamil Nadu | Tirunelveli Medical College,Tirunelveli | 2 |
| 23 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Tamil Nadu | Madurai Medical College, Madurai | 3 |
| 24 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Tamil Nadu | Kilpauk Medical College, Chennai | 2 |
| 25 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Tamil Nadu | Thanjavur Medical College,Thanjavur | 2 |
| 26 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Tamil Nadu | Govt. Mohan Kumaramangalam Medical College, Salem- 30 | 2 |
| 27 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Tamil Nadu | Sri Ramachandra Medical College & Research Institute, Chennai | 2 |
| 28 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Telangana | Osmania Medical College, Hyderabad | 1 |
| 29 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Uttarakhand | All India Institute of Medical Sciences, Rishikesh | 20 |
| 30 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Uttar Pradesh | Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow | 10 |
| 31 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Uttar Pradesh | Dr. Ram Manohar Lohia Institute of Medical Sciences,Lucknow | 2 |
| 32 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Uttar Pradesh | Command Hospital, Lucknow | 2 |
| 33 | M.Ch - Surgical Gastroenterology/G.I. Surgery | Uttar Pradesh | King George Medical University, Lucknow | 3 |
| 34 | M.Ch - Surgical Gastroenterology/G.I. Surgery | West Bengal | Institute of Postgraduate Medical Education & Research, Kolkata | 1 |
Syllabus
An MCh in Surgical Gastroenterology is a three years specialization course that provides training in the stream of Surgical Gastroenterology.
The course content for MCh in Surgical Gastroenterology is given in the Competency-Based Postgraduate Training Programme released by National Medical Commission, which can be assessed through the link mentioned below:
BASIC SCIENCES AND PRINCIPLES OF SURGICAL GASTROENTEROLOGY and GI ONCOLOGY
• Anatomy: Gross and histological anatomy of the abdomen and its contents including the entire GI tract, Liver (including segmental anatomy), Biliary tract, Pancreas, spleen, portal, and Hepatic venous system.
• Physiology: Normal function of the GI tract and related organs including endocrine functions of the gut and pancreas. Physiological basis of various tests to study these functions
• Pharmacology of drugs used in GI surgical disorders e.g. to control acid secretion, in the management of ulcerative colitis, and immunosuppressive drugs.
• Fluid-electrolyte and acid-base disturbance: general aspects, imbalance in GI surgical patient's physiological responses to volume and osmolality abnormalities, interpretation of blood gas analysis, maintenance and replacement therapy.
• Nutritional considerations in GI surgical patients: nutrient stores and body compositions, nutrient requirements, malnutrition, evaluation of nutritional status, nutritional therapy, enteral and parenteral therapy, and complications of these.
• Wound healing: Principles, phases, types of healing, factors influencing wound healing, wound dehiscence, and management.
• Principles and disorders of hemostasis.
• Immunology in GI surgery. Especially about organ transplantation and GI Oncology.
Oesophagus
• Anatomical detail, physiology of swallowing, oesophageal manometry, pH monitoring, endoscopic ultrasound, and other diagnostic techniques, brush cytology, vital staining, contrast imaging, and CT scan,
• Congenital lesions (trachea-oesophageal fistula), Zenker's diverticulum, epiphanic diverticulum, oesophageal trauma, spontaneous or iatrogenic perforations, esophageal motility disorders
• Corrosive burns: detection, evaluation, and management,
• Gastroesophageal reflux disease, achalasia cardia. Barrett's esophagus, oesophageal cancer: adeno & squamous, various oesophageal operations: diverticulectomy, excision of leiomyoma, oesophagostomy, myotomy, fundoplication, oesophageal resection (Ivor lewis, McKeown, Trans-hiatal)
• Cervical exploration, oesophagogastrostomy, gastric pull-up, gastric and colonic bypass, complications of oesophagectomy, management of chylothorax.
Stomach and Duodenum
• Anatomical details, physiology of gastric secretions, gastroduodenal motility, diaphragmatic hernia (congenital and acquired), volvulus, pyloric stenosis in children and adults, foreign bodies (bezoars), stomach trauma,
• H. pylori in gastric diseases, peptic ulcer, Zollinger-Ellison syndrome, non-ulcer dyspepsia
• Gastric tumors: benign and mlignant, gastric surgery: vagotomy, pyloric drainage, gastrojejunostomy
• Bariatric procedures, Creation of gastric tube, Roux-en-Y oesophagojejunal anastomosis, post-gastrectomy syndromes, and complications.
The Liver
A. Anatomy, Embryology, Physiology, Investigations
1. Embryology of the liver and relationship to other foregut structures
2. Extrahepatic anatomy of the liver
• Lobes, sectors, segments
• Nomenclature systems
• Ligaments, fissures and incisures
• Anomalies
3. Anatomy of the porta hepatis
• Portal vein, hepatic artery
• Bile duct, gall bladder
• Variants of normal and anomalies
• Lymphatic drainage and lymph nodal anatomy
• Nerves
4. Anatomy of the retrohepatic space
• IVC and its branches
• Adrenal, kidney, diaphragm 5. Intrahepatic anatomy
• Hepatic veins and variants of normal
• Portal triad structures and segmental anatomy
• Histology of the normal liver
6. Physiology of the liver
• Bilirubin metabolism
• Coagulation
• Other clinically relevant metabolic pathways
7. Haematologic, biochemical, and histologic investigations (assessment) of the liver
Transaminases and markers of cholestasis
• Measures of liver function
(a) Static: including INR (PT), Factors V and VII, bilirubin, albumin
(b) Dynamic: including clearance tests, e.g. ICG, galactose, aminopyrine, lidocaine (MEGX)
(c) Indicators of portal hypertension including hepatic venous pressure gradient
• Indications for liver biopsy
8. Imaging of the liver
• Ultrasound and Doppler, Computerized Tomography (CT) Scans, Magnetic Resonance Imaging (MRI) Scans
• Nuclear tests: Proton Emission Tomographic (PET) Scans, Liver/Spleen scans, Biliary excretion (e.g. HIDA) scans, RBC scans
9. Application of investigations to hepatic surgery
Congenital and Acquired Non-neoplastic Liver Disease
1. Paediatric liver diseases, Biliary atresia, and Alagille's syndrome
(a) Presentation, evaluation, and natural history
(b) Treatment options and indications for intervention
2. Liver cysts and abscesses a. Solitary liver cysts
• Presentation, evaluation, and natural history
• Distinguish from cystic neoplasm
• Treatment options and indications for intervention b. Polycystic liver disease • Associated abnormalities
• Presentation, evaluation, and natural history
• Treatment options and indications for intervention
c. Pyogenic and fungal liver abscess
▪ Potential bacterial and fungal pathogens and sources
• Presentation, evaluation
▪ Treatment and indications for surgical drainage of liver abscess including amoebic abscess
d.Tuberculous abscess
• Presentation, evaluation, and natural history
• Treatment options and indications for intervention
. Echinococcal liver cyst • Life cycle, epidemiology, target organs
• Presentation, evaluation, and natural history
• Treatment options and indications for intervention
3. Liver failure
• Hepatitis and acute liver failure
▪ Causes of acute liver failure
▪ Investigation and prognosis
▪ Classification systems including MELD and King's College criteria
▪ Treatment strategies
▪ Role of liver support systems
▪ Role of liver transplantation
▪ 4. Cirrhosis and portal hypertension
(a) Causes of cirrhosis, diagnosis, and natural history, staging, and treatment options (including indications for liver transplantation) for each
i. Viral hepatitis B, C, D
ii. Alcoholic liver disease
iii. Non-alcoholic fatty liver disease and steatohepatitis
iv. Autoimmune liver disease
v. Primary biliary cirrhosis
vi. Primary sclerosing cholangitis
vii. Haemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency
viii. Budd–Chiari syndrome
(b) Portal hypertension
i. Pathophysiology
ii. Interpretation of haematologic and biochemical tests and imaging
iii. Non-operative treatment options and strategies
iv. Portosystemic decompression
1. Indications and sequelae
2. Risks and benefits of TIPS
3. Surgical shunts, types
4. Devascularisation procedures
v. Indications for liver transplantation
. Neoplastic Liver Disease
a. Benign neoplasms of the liver
• Presentation, investigation, diagnosis, and natural history of haemangioma, hamartoma, adenoma, focal nodular hyperplasia
• Histology and indications for biopsy
• Treatment options and indication for ablation or resection
b. Primary malignancies of the liver
1. Hepatocellular carcinoma (HCC)
▪ Aetiology, presentation, investigation, diagnosis, and natural history of HCC
▪ Role of screening and staging systems for HCC
▪ Treatment options and the risk–benefit ratio for each: resection, transplantation, ablation, chemotherapy with or without embolization, radiation 2. Cholangiocarcinoma (intrahepatic or peripheral)
• Diagnosis, investigation, and staging
• Treatment options including palliative procedures
3. Epithelioid haemangioendothelioma, lymphoma, sarcoma, and other neoplasms • Diagnosis, investigation, and staging
• Treatment options
c. Secondary malignancies of the liver
❖ Colorectal primary
• Pathogenesis, staging of colorectal cancer
• Investigation and staging
• Treatment options
➢ Indications, and risk-benefit ratio of ablation/resection
➢ Neo-adjuvant, downstaging, and adjuvant chemotherapy
❖ Neuroendocrine and other primaries
• Investigation and staging • Treatment options
➢ Indications, and risk-benefit ratio of ablation/resection
➢ Neoadjuvant and adjuvant therapy
Liver Surgery Types of liver resection
• Nomenclature of liver resections (Brisbane system)
• Laparoscopic, laparoscopic-assisted, open laparotomy
• Non-anatomic, segmental, lobectomy, extended lobectomy
• Vascular control: none, Pringle maneuver, total vascular isolation
• Vascular resection and reconstruction
• Staged resections
• Combination with ablation Preoperative assessment and the cumulative risks to the proposed procedure
• Patient comorbid conditions (cardiopulmonary and other)
• Hepatic risk
(a) Assessment of liver function, portal hypertension
(b) Volumetric assessment of liver remnant
(c) Portal vein embolization Preoperative management
• Prophylaxis against common complications such as DVT, infection
• Neuroendocrine hormonal blockade
Detailed operative plan based on preoperative imaging Liver resection
1. Anaesthetic considerations: Agents, coagulation, CVP
2. Blood loss conservation including cell saving and blood product administration
3. Laparoscopic techniques (a) Patient and port placement (b) Hand port
4. Parenchymal transection techniques (a) Relative advantages and disadvantages (b) Normal, fatty, fibrotic, and cirrhotic parenchyma (c) Laparoscopic or open
5. Concomitant resection and reconstruction of the
(i) Diaphragm
(ii) IVC
(iii) Portal vein
(iv) Bile duct and
(v) hepatic artery Post-operative management Complications and management, including liver failure
. Liver Transplantation
• History of Liver Transplantation
• Liver Transplantation in India
• Indications and Contraindications for Liver Transplantation
• Organ Preservation in Liver Transplant
• Anesthetic Management in Liver Transplantation
• Immunology of Liver Transplantation
• Pediatric Liver Transplant
• Liver Transplantation in Acute Liver Failure
• Deceased Donor Liver Transplantation
• Living Related Liver Transplantation
• Complications in Living Donor Liver Transplantation
• Machine perfusion, split liver transplants, reduced size organ transplants, domino transplants
5.5 The Biliary Tract including Gallbladder A. Anatomy, Embryology, Physiology, Investigations
1. Embryology of the biliary tract
• Relationship to the liver, pancreas, and other portal and foregut structures
2. Anatomy of the hepatic duct and biliary plate
• Segmental anatomy and variants of normal • Blood supply and lymphatic drainage
• Relationship with other portal structures
3. Anatomy of the gallbladder and cystic duct
• Blood supply and lymphatic drainage
• Variants of normal and anomalies
4. Anatomy of the bile duct
• Blood supply, lymphatic drainage, and regional lymph nodes
• Variants of normal and anomalies
• Relationship with other portal structures and the pancreatic duct
• Sphincter of Oddi and ampulla of Vater
5. Bile metabolism and biliary physiology
• Bile-salt dependent and independent bile production
• Hormonal influences
• Biliary epithelium and gallbladder function
• Sphincter of Oddi motility
6. Interpretation of biochemical investigations
7. Imaging
• Axial and body imaging techniques: U/S, CT scan and MRI scan, including MRCP • Endoscopic U/S
• Direct contrast imaging
(a) Percutaneous transhepatic cholangiogram (PTC) and cholecystography
(b) Endoscopic retrograde cholangiopancreatography (ERCP)
• Endoscopic assessment of the ampulla of Vater
• Nuclear biliary excretion imaging (HIDA scan) – qualitative and quantitative
Congenital and Non-neoplastic Biliary Disease
a. Congenital and pediatric Choledochal cyst, Caroli's disease, congenital hepatic fibrosis, biliary atresia, and Alagille's syndrome
1. Presentation, classification, evaluation, and natural history
2. Treatment options and indications for intervention
b. Gallstones
1 Pathogenesis
2 Presentation and investigation of biliary colic, cholecystitis, cholangitis, Mirrizzi's syndrome, gallstone ileus
3 Treatment: Percutaneous, laparoscopic and open
4 Cholecystectomy-related biliary injuries
(a) Mechanism of injury and classification
(b) Associated injuries (
c) Management
c. Benign strictures
1 Primary sclerosing cholangitis (PSC)
(a) Aetiology, pathophysiology, natural history, and nonoperative management
(b) Complications and management
i. Screening for cholangiocarcinoma
ii. PTC with biliary drainage (PTBD), ERCP with endo-biliary stent
iii. Resection iv. Transplantation
(2) Post-traumatic and idiopathic
(a) Mechanism of injury and classification
(b) Management options d. Intrahepatic stones
1. Pathophysiology, presentation, and investigation
2. Common infectious bacteria
3. Surgical options including liver resection and biliary access (Hutson) choledochojejunostomy, hepaticojejunostomy with transhepatic stents
C. Neoplastic Biliary Disease a. Gallbladder
(1) Polyps 1. Presentation, natural history
2. Indications for resection
3. Principles of resection
(2) Adenocarcinoma
1. Presentation, staging (including histology), and natural history
2. Investigation
3. Surgical options: Extent and timing of resection
4. Chemo and radiotherapy including neo- and/or adjuvant therapy
5. Palliative care options
b. Bile duct
(1) Adenoma of ampulla of Vater
1. Presentation, natural history, investigation
2. Resection options: Endoscopic, transduodenal resection, and reconstruction
(2) Adenocarcinoma
1. Location: Hilar (Klatskin), intrapancreatic, ampulla
2. Type: papillary, sclerosing
3. Presentation, investigation, and staging, including laparoscopic staging
4. Resection and reconstruction: indications and contraindication
5. Palliative options 1. PTBD or endoscopic stent 2. Surgical bypass
5.6 The Pancreas and Duodenum
A. Anatomy, Embryology, Physiology, Investigations
• Embryology of the pancreas and duodenum (
1) Relationship to the liver, bile duct, and other foregut structures
(2) Aetiology of anomalies including pancreas divisum and annular pancreas
• Anatomy of the pancreas
(1) Spectrum of normal anatomy and variants
(2) Arterial supply and venous drainage
(3) Lymphatic drainage and regional lymph nodes.
(4) Relationship with:
• Portal structures: duodenum, bile duct, hepatic artery, portal vein, splenic and superior mesenteric veins, and their branches
• Retroperitoneum: IVC and its branches, aorta, and SMA and their branches, adrenal gland, kidneys
• Adjacent organs: stomach, spleen, colon, small intestine
• Anatomy of the pancreatic duct
• Variants of normal and anomalies
• Anatomy of the duodenum (
1) Spectrum of normal anatomy and variants
(2) Arterial supply and venous drainage
(3) Lymphatic drainage and regional lymph nodes.
(4) Relationship with:
▪ Portal structures: bile duct, hepatic artery, portal vein, splenic and superior mesenteric veins, and their branches.
▪ Retroperitoneum: IVC and its branches, aorta, and SMA and their branches, adrenal gland, kidneys.
▪ Adjacent organs: pancreas, stomach, spleen, colon, small intestine
• Pancreatic metabolism and physiology
(1) Exocrine enzyme physiology
(a) Synthesis, excretion, and activation
(b) Neural and hormonal influences
(2) Endocrine metabolism
(a) Islet cell function, neuroendocrine hormones
• Duodenal physiology
(1) Motility
(2) Neuroendocrine ("gut") hormone physiology
(3) Biochemical investigation and interpretation
• Biochemical investigations
(1) Markers of pancreatic injury
(2) Measures of pancreatic exocrine function
(3) Urinary and serum neuroendocrine hormones
• Imaging (1) Axial and body imaging techniques: U/S, CT scan, and MRI scan, including MRCP
(2) Endoscopy and endoscopic U/S
(3) Direct contrast imaging: Endoscopic retrograde cholangiopancreatography (ERCP) (4) Nuclear studies:
▪ PET scan
▪ Neuroendocrine imaging (Octreotide scan)
(5) Application of investigations and imaging to pancreatic and duodenal surgery
B. Congenital and Acquired Non-neoplastic Pancreatic Disease
1. Pancreatitis
(1) Acute
1. Pathogenesis, staging, and prognosis
2. Management, including surgical options and complications
3. Indications for surgical intervention
(2) Chronic
1. Pathogenesis, complications, and nonoperative management
2. Pancreatic stents and endoscopic/percutaneous drainage procedures
3. Surgical options and indications
4. Pain control
2. Pancreas divisum
(1) Pathogenesis, staging, and prognosis
(2) Management, including surgical options and complications
(3) Indications for surgical intervention
3. Annular Pancreas
(1) Pathogenesis, staging, and prognosis
(2) Management, including surgical options and complications
(3) Indications for surgical intervention
C. Neoplastic Diseases
1. Benign cysts and neoplasms of the pancreas
(1) Microcystic serous cystadenoma
(a) Presentation, investigation, diagnosis, and natural history
(b) Histology and indications for biopsy
(c) Treatment options and indication for resection
(2) Mucinous cystic neoplasm
(a) Presentation, investigation, diagnosis, and natural history
(b) Histology and indications for aspiration/biopsy
(c) Treatment options and indication for resection
(3) Intraductal papillary mucinous neoplasm (IPMN)
(a) Presentation, investigation, diagnosis, and natural history
(b) Histology and indications for aspiration/biopsy
(c) Treatment options and indication for resection
(4) Solid pseudopapillary neoplasms
(a) Presentation, investigation, diagnosis, and natural history
(b) Histology and indications for aspiration/biopsy
(c) Treatment options and indication for resection
(5) Cystic neuroendocrine tumors
(a) Presentation, investigation, diagnosis, and natural history
(b) Histology and indications for aspiration/biopsy
(c) Treatment options and indication for resection
(6) Von Hippel Lindau syndrome
(a) Pathology, associated lesions, investigation
(b) Management
2. Malignancies of the pancreas
(A) Primary
(1) Adenocarcinoma
a) Presentation, investigation, and staging
b) Assessment of resectability
c) Pre-, peri- and postoperative management
d) Palliative procedures
(2) Neuroendocrine tumors
a) Presentation, investigation, and staging
b) Assessment of resectability
c) Pre-, peri- and post-operative management
(3) Lymphoma
a) Presentation, staging
b) Role of surgery
(B) Secondary
(a) Renal cell carcinoma: Presentation and management
(b) Melanoma: Presentation and management
D. Diseases of the Duodenum
1. Congenital disorders of the duodenum
(1) Duodenal atresia and duplication
(2) Duodenal diverticulae
2. Duodenal ulcer disease
(1) Pathogenesis, investigation, and diagnosis
(2) Nonoperative treatment
(3) Operative management
3. Benign neoplasms
(1) Adenoma
(2) Hereditary Familial Polyposis: Genetics, presentation, investigation, and management
4. Malignant neoplasms of the duodenum
(1) Adenocarcinoma: Presentation, investigation, staging, and management
(2) Gastrointestinal stromal tumor (GIST) and sarcomas: Presentation, investigation, staging, and management
(3) Neuroendocrine tumor: Presentation, investigation, staging, and management
(4) "Secondary" to direct invasion of adjacent malignancy
• Carcinoma of the stomach or colon
• Renal cell carcinoma
• Investigation, staging
• Operative management
5.7 Peritoneum
• Omentum, Retroperitoneum Recesses, reflections, subdiaphragmatic spaces, peritonitis
• Primary secondary and tertiary, tuberculosis, mesenteric cyst, pseudomyxoma peritonei, ascites (diagnosis, investigation, and management), retroperitoneal tumors, inguinal hernia, ventral hernias, peritoneoscopy
5.8 Spleen
• Anatomy, splenic function, hemolytic anemias, splenomegaly hypersplenism, splenic trauma, cysts and granulomas, physiological effects of splenectomy, OPSI, splenic vein thrombosis, splenic artery aneurysms, splenectomy, splenic preservation.
5.9 Small Intestine
• Mesenteric vascular anatomy, intestinal physiology, Ladd's band, malrotation, volvulus, hernia, intestinal obstruction, ileocaecal TB, lymphoma, Benign and malignant tumors of the small intestine
• Meckel's diverticulum, intussusception, small bowel gangrene, intestinal resections, lengthening and transplantation, acute and chronic mesenteric ischemia, short gut syndrome, small bowel fistulae
• Crohn's and other inflammatory bowel diseases enteral feeding, home/parenteral nutrition. 5.10 Colon, Rectum and Anal Canal
• Anatomy, physiology, colonic motility, physiology of defecation and anal continence; Hirschsprung's disease, anorectal malformations, rectal prolapse, SRUS, pseudo-obstruction (Ogilvie syndrome), descending perineum syndrome, anismus, and constipation, anal incontinence
• Haemorrhoids, fissures, fistulae, and anal stricture; polyps and other benign tumors hereditary and familial polyposis syndrome, ulcerative colitis and Crohn's amoebic colitis, ischemic colitis, diverticulitis, lower GI hemorrhage, carcinoma of the colon, rectum, anal canal
• Operations: Abdominoperineal, low and ultra-low anterior resection, segmental colectomies, pelvic exenterations, colostomy, ureterosigmoidostomy, hemicolectomies, urinary diversions, surgery for anal incontinence, rectal prolapse and complex fistulae, restorative proctocolectomy and ileoanal pouch anastomosis
5.11 Imaging
• The applied physics and technology of Ultrasound and Doppler, CT Scan, MRI Scan, PET Scan, and the other nuclear medicine imaging procedures
• The clinical protocols available for each technology
• (1) The information provided by each protocol
• (2) The interpretation of images
(3) The application to clinical investigation
• Imaging algorithm for the investigation of luminal, hepato-biliary, and pancreatic lesions:
5.12 Oncology
1. Basic pathophysiology of neoplasia
(1) Mechanisms of carcinogenesis
(2) Genetic alterations
(3) Viral carcinogenesis
(4) Chronic inflammation
(5) Tumour biology including the potential for metastases
2. Chemotherapy
(1) Classes of drugs
(2) Mechanisms of action
(3) Toxicities
(4) Combination therapy and available protocols
3. Radiation therapy
(1) Applied physics and technology
(2) Mechanism of action
(3) Toxicity
(4) Combination protocols with chemotherapy
4. Multidisciplinary management: Relative roles of surgery, ablation, chemotherapy, and radiation therapy as:
(a) Definitive management
(b) Neo- and adjuvant therapy
(c) Therapy for recurrent disease
5. Palliative therapy
5.13 Trauma
1. Liver trauma
(1) Mechanisms of injury and presentation
(2) Diagnosis and classification of liver lacerations
(3) Management • Angiography and embolization
• Liver parenchyma hemostasis techniques
• Total vascular exclusion with or without IVC shunt or venovenous bypass for retrohepatic IVC and/or hepatic vein injuries
• Resection
(4) Complications: diagnosis and management
2. Biliary tract and portal structures
(1) Mechanisms of injury and presentation
1. "External" trauma 2. Operative injury during cholecystectomy
(2) Investigation, diagnosis, and classification of bile duct injuries: Identification of associated injuries
(3) Management
(a) Timing and role of ERCP + stent and PTBD
(b) Principles and techniques of biliary reconstruction
(4) Complications: diagnosis and management
3. Pancreatic and duodenal trauma
(1) Mechanisms of injury and presentation
(2) Investigation, diagnosis
(a) Identification of pancreatic duct disruption
(b) Identification of duodenal injury
(3) Management
(a) Indications for pancreatic resection
(b) Techniques for the repair of duodenal injuries
(4) Complications: diagnosis and management
5.14 Transplantation
a. Organ procurement
• Brain death and donor management
• Deceased donor hepatectomy and pancreatectomy
• Living donor assessment
(a) Living donor left or right hepatectomy
• Organ preservation: Principles and application
b. Transplantation
(1) Indications for liver transplantation
(a) Acute and chronic liver failure
(b) Hepatocellular carcinoma and other liver tumors
(c) Childs' and MELD scores and organ allocation
(2) Liver
(a) Transplant hepatectomy
(b) Liver transplant techniques
(3) Pancreas
(a) Backbench reconstruction
(b) Pancreas transplant
(4) Immunosuppression: Drugs, mechanisms of action, toxicities, and combination therapy
(5) Complications of transplantation
(a) Surgical
(b) Infectious
(c) Immunologic
5.15 Miscellaneous
• Variceal Upper Gastrointestinal Bleeding Management of Nonvariceal Hemorrhage
• Approach to the Management of Lower Gastrointestinal Hemorrhage
• Bariatric and Metabolic Surgery
• Robotics in Gastrointestinal Surgery
• Tumor Markers in Gastrointestinal Malignancy Chylous Ascites
• Acute Postoperative Pain and its Management in Major Abdominal Surgeries
• Telemedicine: Principles and the Surgery for Portal Hypertension
• System-based approach and
• Role of Disease Management Groups (DMG) or Multi-Disciplinary Teams (MDT) for GI Oncology and Chronic GI disorders
5.16 General
1. Approach to a Patient of Digestive Disease
2. Gastrointestinal Imaging
3. Infections and Antibiotics in Gastrointestinal Surgery, Response Syndrome (SIRS), multiple organ dysfunction syndromes (MODS), immunology about transplantation and rejection, intensive care, and respiratory support
4. Nuclear Medicine Imaging in Gastrointestinal Diseases and GI Oncology
5. Radiation Therapy
6. Minimal Access Surgery in GI Surgery and GI Oncology
7. Chemotherapy Principles and Techniques for Gastrointestinal Cancers
8. Nutritional Support to Hospitalized Patients, Surgical nutrition- parenteral and enteral, iatrogenic complications of surgery like enterocutaneous fistulae, biliary strictures, intrabdominal sepsis/collections, AIDS, hepatitis and surgeons, renal failure, shock, disorders of coagulation, Surgery for morbid obesity
9. Research Methodology, Data Science Management, and Statistics for Surgeons
10. Interventional Radiology of the Gastrointestinal Tract and Hepatobiliary System
11. Tumour genetics- oncogenes, tumor markers, Systemic Inflammatory
12. Biostatistics, Data management, Research Methodology, and Clinical Epidemiology
13. Ethics
14. Medico-legal aspects relevant to the discipline
15. Health Policy issues as may apply to the discipline
Career Options
After completing an MCh in Surgical Gastroenterology, candidates will get employment opportunities in Government as well as in the Private sector.
In the Government sector, candidates have various options to choose from which include Registrar, Senior Resident, Demonstrator, Tutor, etc.
While in the Private sector, the options include Resident Doctor, Consultant, Visiting Consultant (Gastroenterologist Surgeon), Junior Consultant, Senior Consultant (Gastroenterologist Surgeon), Assistant Professor, Associate Professor (Gastroenterologist Surgeon).
Courses After MCh in Surgical Gastroenterology Course
MCh in Surgical Gastroenterology is a specialization course that can be pursued after finishing a Postgraduate medical course. After pursuing a specialization in MCh in Surgical Gastroenterology, a candidate could also pursue certificate courses and Fellowship programs recognized by NMC and NBE, where MCh in Surgical Gastroenterology is a feeder qualification.
These include:
- Fellowship in Paediatric Surgical Gastroenterology (AIIMS)
Frequently Asked Questions (FAQs)-MCh in Surgical Gastroenterology Course
· Question: What is the full form of an MCh?
Answer: The full form of an MCh is Master of Chirurgiae.
· Question: What is an MCh in Surgical Gastroenterology?
Answer: MCh Surgical Gastroenterology or Master of Chirurgiae in Surgical Gastroenterology also known as MCh in Surgical Gastroenterology is a super specialty level course for doctors in India that is done by them after completion of their postgraduate medical degree course.
· Question: What is the duration of an MCh in Surgical Gastroenterology?
Answer: MCh in Surgical Gastroenterology is a super specialty program of three years.
· Question: What is the eligibility of an MCh in Surgical Gastroenterology?
Answer: The candidates must have a postgraduate medical Degree in MS/DNB (General Surgery) obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE., this feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.
- Question: What is the scope of an MCh in Surgical Gastroenterology?
Answer: MCh in Surgical Gastroenterology offers candidates various employment opportunities and career prospects.
- Question: What is the average salary for an MCh in Surgical Gastroenterology candidate?
Answer: The MCh in Surgical Gastroenterology candidate's average salary is between Rs. 35 lakhs to Rs. 50 lakh per annum depending on the experience.
•Question: Can you teach after completing an MCh Course?
Answer: Yes, the candidate can teach in a medical college/hospital after completing an MCh course.
- Question: What are the options for pursuing further studies after M.Ch Gastroenterology Surgery?
Answer: After the completion of M.Ch Gastroenterology Surgery doctors may look forward to Doctoral/Research Level courses such as Ph.D. in Gastroenterology Surgery or apply for a fellowship program.
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