The Advanced Endoscopy Fellowship provides intense endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) training with the goal of developing future leaders in the field.

The program can be tailored to meet individual needs, allowing greater emphasis on either EUS or ERCP to facilitate research efforts.

In addition, you actively participate as a member of the GI Bleeding Team and in the interpretation of capsule endoscopy. Exposure to other advanced procedures, such as endoscopic mucosal resection (EMR) and luminal stenting, is made available depending on your needs and existing opportunities.

An animal lab is available in which you may design and perform animal studies, and acquire basic skills and enhanced exposure to new and advanced endoscopic techniques. A complete text and video library is available to augment teaching.

Clinical training

Upon completion of the Advanced Endoscopy Fellowship, you should be able to:

• Use EUS and ERCP to diagnose and manage patients with a variety of GI disorders
• Identify the unique features of dedicated echoendoscopes, catheter probes, and EUS and ERCP accessories
• Identify normal and abnormal EUS and ERCP anatomy
• Establish the T, N and M stage for luminal tumors and pancreatic cancer
• Differentiate the various types of cystic pancreatic tumors
• Identify the utility of EUS for evaluating patients with chronic pancreatitis, including autoimmune pancreatitis
• Differentiate the various subepithelial mass lesions
• Assess the N stage for lung cancer
• Integrate EUS into the care of patients with inflammatory bowel disease
• Demonstrate proper technique for EUS-guided biopsy (FNA, Tru-Cut)
• Demonstrate proper technique for selective biliary and pancreatic cannulation, endoscopic sphincterotomy, precut sphincterotomy, and needle-knife sphincterotomy
• Recognize the technical aspects and role of interventional EUS and ERCP procedures, including but not limited to stone retrieval, cyst drainage, stent insertion and retrieval, removal of migrated stents, rendezvous procedures, pseudocyst drainage, celiac plexus block and neurolysis, duodenal and other luminal stenting, and endoscopic ampullectomy
• Begin the process of overseeing and teaching these skills and techniques to other gastroenterology fellows
• Integrate proper reimbursement and billing into your practice

Didactic training

In addition to hands-on performance of these techniques, the curriculum includes a series of didactic lectures. These lectures are provided by the EUS and ERCP staff, other GI and non-GI physicians who utilize these techniques, radiologists, oncologists, and advanced fellows.

Conferences

In addition to the weekly GI divisional and research conferences, there are separate endoscopy conferences and meetings. As an advanced fellow, you are responsible for presenting at several of these forums and coordinating intermittent advanced endoscopy meetings.

Research training

Regular and structured meeting are held between fellows and identified mentors to design and conduct research protocols. Fellows also work with other members of the Division of Gastroenterology and Hepatology with diverse skills and investigative backgrounds. Research projects are further developed and implemented in one of our varied GI subspecialty clinics and interest groups.

You have dedicated blocks of time for work on mutually agreed-upon research projects. The development of at least one prospective EUS-based or ERCP-based study is required. It is expected that you also complete one retrospective study and one review article. You are encouraged to initiate the planning and dialogue of at least one of these studies before starting the fellowship.

As an advanced fellow, you are expected to enroll patients who are undergoing procedures into already approved clinical protocols in which you are involved.

Publications and presentations

It is anticipated that each of the prospective studies developed will generate results and information suitable for publication in a major GI subspecialty journal. Two additional critical manuscripts are expected. These may include a major subject review, case report (limited to one only) or a retrospective review.

The development of abstracts for at least two of the major national GI meetings — Digestive Disease Week (American Gastroenterological Association and American Society for Gastrointestinal Endoscopy) in the spring and American College of Gastroenterology in the fall — also is anticipated.

Call frequency

Advanced endoscopy fellows are infrequently on call. The fellow is expected to cover patients treated in the advanced procedural units if their discharges are delayed past normal outpatient unit hours. You are responsible for disposition of outpatients cared for in the endoscopy suites.

If you want to be involved in emergency or weekend ERCP procedures, this is possible but not required. However, you are expected to keep a pager on in the evening to field calls from patients who may have complications or questions, so these issues can be managed by phone or triaged appropriately. Such calls are not usual.

Teaching opportunities

Opportunities are available for teaching rotating gastroenterology fellows in the endoscopy suites, as well as residents and fellows during conferences and while covering the GI Bleeding Team.

Moonlighting

One year is spent on focused training and research, so moonlighting is generally not allowed.

Evaluation

To ensure you gain proficiency and develop the corresponding technical skills, your performance is monitored throughout the Advanced Endoscopy Fellowship. You are formally evaluated by your supervising faculty member after completing each clinical rotation, and then you meet with the program director to review these evaluations. In addition, you regularly evaluate the faculty to ensure your educational goals are being met.