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Gastroenterology and Hepatology Fellowship

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.

Welcome! From the Program Director

Headshot of Jenifer Palagiri

As an alumna of Saint Louis University School of Medicine’s Gastroenterology Fellowship program, I am intimately familiar with the rigors and rewards of training here. Our program’s goal is to create well-rounded gastroenterologists capable of meeting twenty-first century needs in a collaborative approach with their patients, other services, and the medical system. Fellows focus on clinical outpatient experiences, inpatient services, research, and special populations. The fellowship program is positioned to grow with trainees and their interests with our talented faculty and staff  facilitating their instruction. Please check out some of the information about our dual pathway fellowships. If you have any questions please don't hesitate to reach out. 

Jennifer Palagiri, M.D.
Assistant Professor
Program Director
jennifer.palagiri@health.slu.edu


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.

This includes the creation of the dual pathway training option where a trainee will be board-eligible in both gastroenterology and transplant hepatology in only three years. 

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.

Fellowship Clinical Services

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. Here is a yearly breakdown:

First Year

  • GI  Service at SSM Health SLUH, VA St. Louis St. Louis Health Care System - John Cochran Division
  • Proficient in basic endoscopic procedures including:
    • Upper endoscopy 
    • Colonoscopy
    • Endoscopic biopsy 
    • Polypectomy
    • Esophageal dilation 
    • Endoscopic hemostasis
    • Percutaneous endoscopic gastrostomy 

Second and Third Year 

  • Liver service 
  • Pancreatiocobiliary service
  • SLU clinics
  • Endoscopy
  • VA Saint Louis Health Care System 
    • John Cochran Division

If a trainee has an interest in completing the dual pathway for gastroenterology and transplant hepatology, they may apply in their first year to begin on the adjusted pathway during their second year. These trainees will have the same robust gastroenterology experiences with the following transplant hepatology-specific experiences:

  • Outpatient rotations with transplant surgery, pediatrics
  • Pathology
  • Participation in liver biopsies
  • Participation in liver procurement

Elective Options

  • Gastrointestinal radiology 
  • Pathology 
  • Pediatric and adolescent gastroenterology 
  • Advance endoscopy 
  • Hepatology 
  • Liver transplantation 
  • Colorectal surgery 
  • Academic leadership/teaching/QI project
Fellowship Research

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. 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. 

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

Training Goals

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.

Transplant Hepatology

Our ACGME-accredited transplant hepatology fellowship is designed for trainees who have already completed their gastroenterology training. Building on the prior training allows this one year fellowship to deepen the trainee’s knowledge, while challenging them with additional skills and procedures. Our program’s goal is to create well-rounded gastroenterologists capable of meeting 21st century needs in a collaborative approach with their patients, other services, and the medical system.

If you have any questions please reach out and let us know. 

Headshot of Alex Befeler

Alex Befeler, M.D. 
Hepatologist
Professor; Medical Director of Liver Transplantation; Program Director, Transplant Hepatology
alex.befeler@health.slu.edu


 

Application Process

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.

Research 

The Division of Gastroenterology and Hepatology at Saint Louis University fosters research from the lab to patient treatment. As a leading research center, we are continually engaged in multi-center clinical trials; we offer our patients access to the latest advances in clinical care.  Our physicians specialize in diagnosing and treating liver diseases that range from evaluation of fatty liver to hepatitis B to management of severe, complicated, end-stage liver disease awaiting transplantation.

To learn about our clinical trials, please call the Gastroenterology and Hepatology Clinical Studies Unit at 314-977-9400 to speak with a research coordinator.

View Current Clinical Trials