Separate GI consult services in University Hospital (UH) 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 residents 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.
Fellows attend weekly continuity-of-care clinics throughout their three years of training, either at Audie Murphy Veterans Hospital or at the Robert B. Green (RBG) Campus of University Health System (UHS). The RBG campus is home to GI, Hepatology and Inflammatory Bowel Disease clinics. These clinics allows 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.
Both UHS and the VA Hospital offer 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, endoscopic mucosal resection (EMR), stricture and achalasia dilation, percutaneous endoscopic gastrostomy and jejunostomy (feeding tube placement), luminal stent placement, and endoscopic hemostasis.
The VA Hospital lab is the site for inpatient and outpatient endoscopy services for veterans in this region. UHS operates both an outpatient endoscopy center at the RBG Campus and inpatient labs at UH that deliver inpatient endoscopy, procedures for high-risk outpatients, and a broad spectrum of advanced endoscopy procedures.
Advanced Procedures (ERCP/EUS)
Endoscopy labs in both UH and the VA Hospital feature on-site fluoroscopy rooms for ERCP and EUS. AE labs at UH and Christus hospital further offer advanced interventions including biliary manometry, SpyglassTM intraductal endoscopy, and laser lithotripsy. Our AE faculty have introduced rapidly growing programs in EMR, endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM).
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 pancreatico-biliary conferences, regular opportunities to perform consultative evaluation of pancreas and biliary patients, 3rd-year rotations on the Pancreas/Biliary service, and opportunities to attend regional and national pancreatico-biliary conferences all add to the training experience in this area.
Since its inception in 1992, the liver transplant program of the University Transplant Center (UTC) has performed over 1000 cadaveric, split liver, and living-donor liver transplants. Supported by a superb full-time multidisciplinary staff that includes liver transplant surgeons and 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. The UTC includes a dedicated Transplant intensive care unit, step-down unit, outpatient clinic and 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 undergoing liver transplantation.
Our facilities include high resolution esophageal manometry, ambulatory esophageal pH monitoring, esophageal impedance testing, breath hydrogen studies, video capsule endoscopy and SmartPill™. Fellows are afforded opportunities to become proficient in the interpretation of all these studies.
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, pediatric ERCP, fistula closure, novel device development, therapy of non-alcoholic fatty liver disease (NAFLD) and developing models for enhancing rural provider education through video-based education. Fellows have 4 months of protected time dedicated to research throughout the fellowship. 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.
The Gastroenterology conference schedule provides comprehensive continuing medical education for the faculty and fellows. Our weekly didactic conferences include Grand Rounds lectures delivered by UT Health San Antonio and San Antonio Uniformed Services Health Education Consortium GI fellowship faculty and fellows and by visiting faculty. These are supplemented by General GI and Advance Endoscopy case-based discussions, journal clubs, board reviews, M&M conferences, radiology conference, pathology conference, hands-on sessions, etc. Fellows participate in several educational activities throughout their fellowship, including Team Based Leaning sessions and traditional lectures for medical students and medicine residents, research and wellness lectures outside of our traditional GI lectures, a Gastroenterology Objective structured clinical examination (OSCE), etc.
Advanced Endoscopy Fellowship
Two fellows are accepted each year into our one-year PGY-7 (non-ACGME accredited) Advanced Endoscopy fellowship. Fellows receive intense training in diagnostic and therapeutic ERCP, EUS and other advanced procedures, engage in research involving advanced endoscopic techniques and participate in mentoring GI fellows in learning about pancreato-biliary medicine.
Transplant Hepatology Fellowship
Newly created, one to two fellows will be accepted each year into a one-year PGY-7 ACGME accredited Transplant Hepatology fellowship. Fellows will receive training in the management of patients with acute and chronic liver disease, including the selection and management of patients that undergo liver transplantation. At the end of training, fellows will fulfill the transplant hepatology milestones and competencies set forth by the American Board of Internal Medicine (ABIM), ACGME, and the United Network for Organ Sharing (UNOS).