GastroenterologyFellowship Program Clinical ActivitiesUntitled Document
Gastrointestinal In-Patient Consultation
Separate GI consult services in University Hospital and Audie Murphy VA Hospital provide gastrointestinal consultation to a broad range of medical and surgical services. Fellows lead the consult services and, in conjunction with the faculty attending, supervise house officers and medical students rotating in GI. During these rotations, the fellow is exposed to a wide variety of patients with diverse manifestations of gut and liver disease.
Out-Patient Consultation
Fellows attend weekly continuity-of-care clinics throughout their three years of training, alternating each week between the Audie Murphy Veterans Hospital and the University Health Center – Downtown (UHC-D), a University Health System facility. These clinics allow fellows to learn the art of consultation in gastrointestinal and liver disease and longitudinally manage a diverse group of patients over the span of their training.
Endoscopy Centers
Both University Hospital and the VA Hospital offer state-of-the-art, high-volume endoscopic laboratories in which fellows learn to deliver a wide range of diagnostic and therapeutic endoscopic and other services. These include upper endoscopy, colonoscopy, polypectomy, stricture dilation, percutaneous endoscopic gastrostomy and jejunostomy (feeding tube placement), luminal stent placement, and endoscopic hemostasis. Both facilities serve both inpatients and outpatients, and fellows receive intense exposure to all manner of emergency endoscopy, including both arterial and variceal hemostasis. Experienced faculty members are present to supervise all routine and emergent procedures performed by fellows.
Advanced Procedures (ERCP/EUS)
Endoscopy labs in both University Hospital and the VA Hospital feature on-site fluoroscopy rooms for ERCP, and University Hospital also features full diagnostic and therapeutic EUS. In addition, we have recently inaugurated a new Advanced Endoscopy center featuring both ERCP and EUS at Christus Santa Rosa-City Centre. Both University Hospital and Christus facilities possess all standard therapeutic ERCP capabilities, as well as manometry, SpyglassTM intraductal endoscopy, and laser lithotripsy. ERCP and EUS procedures are performed by 4th-year Advanced Endoscopy fellows, but close proximity allows excellent opportunities for GI fellows to observe procedures and familiarize themselves with the basics of both performance and interpretation. (Limited opportunities for hands-on ERCP/EUS experience may be available for GI fellows, but full training in these procedures is not feasible in the GI fellowship.) Monthly Pancreatobiliary conferences, regular opportunities to perform consultative evaluation of pancreas and biliary patients, and 3rd-year rotations on the Pancreas/Biliary service all add to the training experience in this area.
Other Procedures
Both University Hospital and VA endoscopy labs feature esophageal manometry, breath hydrogen testing, ambulatory pH monitoring, and capsule endoscopy. Fellows are afforded opportunities to become proficient in the interpretation of all these studies.
Liver Transplantation
Since its inception in 1992, the Liver Transplant program at University Health System has performed over 1100 cadaveric, split liver, and living-donor liver transplants. Supported by a superb full-time multidisciplinary staff that includes 6 liver transplant surgeons and two transplant hepatologists, this program boasts superb patient outcomes and offers our GI fellows an excellent opportunity to gain in-depth experience in this crucial area of Hepatology practice.

Patients are followed regularly by the Transplant Hepatology service at the modern J. Kent Trinkle Center for Transplant Sciences. This center serves as a dedicated facility for the care of solid organ transplant recipients and consists of a 12-bed intensive care unit, a 17-bed step-down unit, an outpatient clinic and a pharmacy. All GI fellows participate in the evaluation and treatment of patients with end-stage liver failure as well as in the perioperative and long-term postoperative management of patients with liver transplantation.

Gastrointestinal Research
There are multiple research projects ongoing in the Division of Gastroenterology and Nutrition, focused on topics ranging from treatment of cholangitis to laser lithotripsy for large bile duct stones, NOTES (natural orifices trans-endoscopic surgery), ERCP in liver transplant patients, effects of laser on biliary epithelium, and pediatric ERCP. Each fellow identifies a faculty research mentor and participates in a research project with the goal being presentation of results at a national scientific meeting.
Advanced Endoscopy Fellowship
Two fellows are accepted each year into our one-year PGY-7 (non-ACGME accredited) Advanced Endoscopy fellowship. Fellows receive an intense training experience in all aspects of diagnostic and therapeutic ERCP and EUS (and other modalities), participate in research involving advanced endoscopic techniques, and participate in mentoring GI fellows in learning about pancreato-biliary medicine.