Gastroenterology European Board

938 best-of-five questions for the European Specialty Examination in Gastroenterology and Hepatology (ESEGH), written by a consultant gastroenterologist working in the NHS and mapped to the current syllabus. The ESEGH replaced the UK SCE in Gastroenterology in 2018, and this bank is written for the European exam as it is now, not for the old SCE.

Hepatology is where most candidates lose marks, because ward experience skews towards luminal work and endoscopy. More than a third of this bank is liver, so the area you have practised least is the one you will have revised most. Sat the ESEGH before and missed the pass mark, or preparing for the first time? Start with the free sample questions and judge the explanations for yourself.

What you get

• 938 ESEGH-style questions. Clinical stems with endoscopy findings, histology, liver screens and imaging, one lead-in, five options, one best answer.
• Explanations written by a gastroenterologist. Each answer gives the mechanism, says why the diagnosis fits, gives the next step under current BSG, EASL, ECCO or ESGE guidance, and explains why the other four options are wrong. Every explanation ends with a Clinical Tip.
• Full syllabus coverage. Oesophagus and stomach, small bowel and coeliac disease, inflammatory bowel disease, colon and GI cancer, pancreas and biliary tract, nutrition, GI infection, GI bleeding, endoscopy and surveillance, and the whole of hepatology: cirrhosis and portal hypertension, viral hepatitis, autoimmune and cholestatic liver disease, MASLD, alcohol-related liver disease, drug-induced liver injury, liver tumours and transplantation.
• Revision notes. Topic notes sit beside the questions, so a wrong answer links straight to the reading you need.
• Progress by topic. See your score in each syllabus area, revisit flagged questions and reset the bank for a second pass.
• Website and app. Revise at home or on the License Medical app between lists; progress syncs. New questions are added free during your subscription.

Which plan?

• 1 month. Used another bank and did not get through? One focused month to close the gaps before you resit.
• 3 months. The plan most first-time passers use: one full pass of the bank and a second pass of hepatology.
• 6 or 12 months. Busy with endoscopy lists and on-calls? Spread it out at under an hour a day and still finish the bank twice before June.

Sample question

A 46-year-old man with compensated cirrhosis due to alcohol-related liver disease, abstinent for two years, attends for surveillance. Ultrasound shows a 2.4 cm lesion in segment VI. Multiphase CT shows the lesion enhances in the arterial phase with washout in the portal venous phase and a surrounding capsule. Alpha-fetoprotein is 18 kU/L. Child-Pugh A5, MELD 8, platelets 165 × 10⁹/L, no ascites, no varices, bilirubin 14 µmol/L. Performance status 0.

What is the most appropriate next step?

A. Image-guided biopsy of the lesion
B. Liver resection
C. Referral for liver transplantation assessment
D. Sorafenib
E. Transarterial chemoembolisation

Answer: B. Liver resection. In a cirrhotic liver, a nodule larger than 1 cm that shows arterial hyperenhancement with portal venous washout on multiphase CT or MRI meets the non-invasive imaging criteria for hepatocellular carcinoma, so biopsy is not needed and carries a small risk of tract seeding. This is a single tumour under 5 cm with preserved liver function, no portal hypertension and good performance status, which is very early or early stage disease; resection is the first-line curative option for a single lesion when liver function is well preserved and there is no clinically significant portal hypertension. Transplantation is the better curative option when resection is not possible because of portal hypertension or impaired function, or when there is multifocal disease within accepted criteria, but it is not first-line when resection is feasible. Chemoembolisation is for intermediate stage, multinodular disease, and sorafenib and other systemic agents are for advanced disease with vascular invasion or spread. Clinical Tip: in cirrhosis, a nodule with arterial enhancement and washout is HCC without a biopsy; a single small tumour with good liver function and no portal hypertension goes to resection.

About the ESEGH

What is it? The European Specialty Examination in Gastroenterology and Hepatology is delivered jointly by the Federation of the Royal Colleges of Physicians of the UK, the British Society of Gastroenterology and the European Board of Gastroenterology and Hepatology. For UK trainees it serves as the Specialty Certificate Examination and is required for a CCT in gastroenterology. Doctors across Europe and beyond can also sit it as a recognised specialty assessment.

What is the format? Two papers on one day, each lasting three hours and each containing 100 best-of-five questions. There is no negative marking.

When is it held? Once a year, usually in June, with applications opening early in the year. Dates, fees and the blueprint are published by the Federation at mrcpuk.org and by the European Board.

When should UK trainees sit it? The UK specialty advisory committee recommends attempting it from ST5 onwards, after enough exposure to both luminal gastroenterology and hepatology to recognise the patterns the questions describe.

What is on the syllabus? The exam follows the European curriculum ("Blue Book") and the UK gastroenterology curriculum. Hepatology makes up a large share of the paper, alongside luminal gastroenterology, nutrition, endoscopy, GI oncology and the basic sciences behind them.

How should I revise? Work through the bank by syllabus area, read every explanation in full, and give hepatology at least as much time as the rest combined if your clinical experience has been mostly luminal. In the final month, do timed blocks of 100 questions to match the pace of the real paper.

Written by a UK consultant gastroenterologist. Every explanation follows current BSG, EASL, ECCO, ESGE and NICE guidance and is reviewed when guidelines change. Preparing for another specialty? See all Specialty Certificate Exam question banks.