The Saint Louis University Division of Gastroenterology and Hepatology has two outstanding fellowships: a three-year gastroenterology fellowship program to train future gastroenterologists and hepatologists and a one-year transplant hepatology fellowship. Our fellows continue to have a 100% pass rate when they take their boards.
Gastroenterology and Hepatology Training
During the program, fellows receive training in the cognitive aspects of consultative gastroenterology and hepatology, in gastrointestinal endoscopy and liver biopsies, and have opportunities for research activities. Fellows also have an opportunity to spend six months in laboratory-based or clinical research. An amalgamation of these clinical, procedural and research experiences provides the foundation for a future career in academic medicine, as well as in a scholarly clinical practice.
The role of the gastrointestinal specialist has been modified with the changes in health care delivery and the advent of managed care. We are cognizant of these changes and we have tried to design our program to be sufficiently flexible to meet the needs of our trainees and to allow for future success.
Complex problems in gastroenterology often require a team approach. We have excellent collaborative relations with GI and liver transplant surgeons, diagnostic and therapeutic radiologists, and GI pathologists who interact with us regularly in the care of our patients and in our research efforts. As a result of this team approach, we are proud to offer the newly ACGME-approved dual pathway training in our fellowship. This is an exciting opportunity for those interested in being board-eligible in both Gastroenterology and Transplant Hepatology. This combined program is designed to be completed in 3 years rather than as separate programs spanning 4 years. Saint Louis University has an active abdominal transplantation program.
A Supportive Environment
Our teaching hospitals provide fellows with experience treating both common medical conditions seen in community settings and complex cases treated at a major academic tertiary care referral center. Our teaching faculty are an enthusiastic and skilled group of educators, including many who are listed on Saint Louis's Best Doctors List. Our faculty and staff are known to be approachable, friendly, and supportive.
Fellows are regularly instructed at the bedside by dedicated clinical educators who provide a truly diverse and varied experience. Fellows develop excellent clinical and patient management skills that allow them to become outstanding physicians in any environment. The program fosters self-governance and ownership of the educational experience by the fellows, encouraging self-directed, lifelong learning.
Fellows and faculty participate in a variety of weekly one-hour conferences including gastroenterology grand rounds, GI fellows case conferences, Journal Clubs, Pathophysiology, Pathology Conference, Nutrition, Radiology Conference and the Liver Cancer Conference.
Fellowship Clinical Services
SSM Health Saint Louis University Hospital and the VA Saint Louis Health Care System - John Cochran Division participate in the training program. Fellows learn consultative gastroenterology and hepatology and patient management in the setting of a tertiary/quaternary university hospital, a public hospital and a community hospital.
During the first year of training, fellows rotate on the gastroenterology service at SSM Health Saint Louis University Hospital and VA Saint Louis Health Care System - John Cochran Division.
Fellows become proficient in basic endoscopic procedures including:
- Upper endoscopy
- Endoscopic biopsy
- Esophageal dilatation
- Endoscopic hemostasis
- Percutaneous endoscopic gastrostomy
The second and third years of training includes rotations on:
- Liver service
- Pancreaticobiliary service
- General gastroenterology service at SSM Health St. Mary's Hospital
- VA Saint Louis Health Care System - John Cochran Division
Electives are presently available in:
- Gastrointestinal radiology
- Pediatric and adolescent gastroenterology
- Advanced endoscopy
- Liver transplantation
- Colorectal surgery
- Academic leadership/teaching/QI project
Fellows receive extensive training in endoscopic screenings and interventions. These include upper endoscopy, colonoscopy, endoscopic biopsy, polypectomy, esophageal dilatation, endoscopic hemostasis, and percutaneous endoscopic gastrostomy. Our team is confident, caring, and efficient. With three fully operational endoscopy suites, two advanced endoscopy rooms, and a physiology lab for motility studies; fellows gain the technique, cognitive skills, and confidence to effectively perform these procedures.
When working with the Liver Service, fellows receive extensive training in the outpatient evaluation and management of patients with a variety of liver diseases. The inpatient experience on the Liver Service includes the evaluation and management of acute liver disease, and pre- and post-transplant problems. Fellows gain extensive experience in performance of liver biopsy and paracentesis.
When working with the Pancreaticobiliary Service, fellows attain extensive experience in the evaluation and management of inpatient and complicated outpatient pancreatic and hepatobiliary disorders. At the completion of this rotation, fellows have generally become proficient in the basic aspects of ERCP (e.g., cannulation of the bile and pancreatic ducts). Although fellows have the opportunity to observe and assist in the more advanced aspects of biliary endoscopy (e.g., sphincterotomy, stent placement, lithotripsy, stone removal, sphincter of Oddi manometry, etc.), proficiency in these areas usually cannot be expected without additional training and/or experience.
VA Saint Louis Health Care System - John Cochran Division
Our partnership with John Cochran VA is multi-faceted with exposure over all three years of fellowship. Fellows cycle through urgent care clinics, endoscopy, and have access to simulation.
Each fellow is expected to complete a research project of clinical or basic science interest. The goal of the research component of the fellowship is to train physicians and basic scientists who want to pursue a career in academic medicine. The program develops independence under the direction of a mentor. A major emphasis of the experience is teaching the skills necessary to perform research and win peer-reviewed funding in our current competitive climate. The research process includes experience in literature review, study design, budgeting, peer review, IRB approval, data collection, statistical analysis, and submission of an abstract for society presentation and publication in a peer-reviewed journal. In addition to the support of the teaching faculty, the fellowship program provides research support consisting of clinical research assistants, computer programming for data analysis, and graphics and audio/visual support for presentations.
Current research activities include:
Investigation into the mechanisms of hepatic fibrogenesis
Mechanism of lipotoxic liver injury (NASH)
Gene regulation of hepatic collagen synthesis
Regulation of hepatic stellate cell activation
Effects of Kupffer cell products on hepatic stellate cells
Role of oxidative stress in hepatic injury
Mechanisms of inflammation and fibrosis in the pancreas
Intracellular signaling in stellate cell
Correlation of hepatic steatosis among cohabitants - NASH and pharmacology
Effect of food reintroduction timing post-scope
Endoscopy for abnormal imaging
A variety of clinical projects are ongoing. These include evaluation of new treatments of NASH, PBC, PSC, ulcerative colitis, Crohn’s disease, hepatocellular carcinoma, hepatorenal syndrome, irritable bowel syndrome and sphincter of Oddi dysfunction, evaluation of new methods for endoscopic control of gastrointestinal hemorrhage, and management of medical problems in the post-transplant setting.
Each fellow must also present their research at our annual year-end research conferences. Fellows are also encouraged to present the results of their research experiences at an annual national meeting, such as the meetings sponsored by the American Gastroenterological Association, the American Association for the Study of Liver Diseases or the American College of Gastroenterology.
The goal of training in the second and third years is for fellows to develop specific skills in keeping with their career goals. Some interested in general gastroenterology practice might be involved in all clinical areas. Someone interested in a research-oriented academic career would place an emphasis on research. And subspecialty resident interested in a career in academic clinical hepatology might do extensive work in the Liver Clinic, with the Liver Transplant Service, and with several clinical research projects. The flexibility of the curriculum in the second and third years allows our fellows to tailor their training according to their career choices.
You may apply for one of our four GI fellowship positions through the Electronic Residency Application Service (ERAS). We accept applications July 1-31 for each interview season. We review applications in early August and invite applicants to interview from late August-October. All of our positions will be filled through the National Residency Match Program (NRMP). We sponsor both H-1B1 and J-1 visas. All application requirements are listed with ERAS.