Fellowship Clinical Services

The participating hospitals in the training program are Saint Louis University Hospital, the John Cochran Veterans Affairs Medical Center, and St. Mary's Health Center. A different spectrum of patients and diseases is seen at each of these hospitals. Subspecialty residents thereby 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, subspecialty residents rotate on the Gastroenterology Service at Saint Louis University Hospital and John Cochran Veterans Affairs Medical Center.

Subspecialty residents become proficient in:

• basic endoscopic procedures:
  • including upper endoscopy
  • colonoscopy
  • endoscopic biopsy
  • polypectomy
  • esophageal dilatation
  • endoscopic hemostasis
  • percutaneous endoscopic gastrostomy

Second and Third Years
The second and third years of training include:

• rotations on the Liver Service
• the Pancreaticobiliary Service
• the general Gastroenterology Service at St. Mary's Health Center
• the John Cochran Vetrans Hoepital
• electives

Electives
Electives are presently available in:

• gastrointestinal radiology
• pathology
• nutrition
• pediatric and adolescent gastroenterology
• gastrointestinal motility
• research
• liver transplantation

Liver Service
When working with the Liver Service, subspecialty residents 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. Subspecialty residents gain extensive experience in performance of liver biopsy and paracentesis.

Pancreaticobiliary Service
When working with the Pancreaticobiliary Service, subspecialty residents attain extensive experience in the evaluation and management of inpatient and complicated outpatient pancreatic and hepatobiliary disorders. At the completion of this rotation, subspecialty residents have generally become proficient in the basic aspects of ERCP (e.g., cannulation of the bile and pancreatic ducts). Although subspecialty residents 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.

Subspecialty Residents
Subspecialty residents rotating through the motility elective will see outpatients in the Motility Clinic and provide subspecialty consultation for motility related problems on the inpatient service. Subspecialty residents will learn the performance and interpretation of esophageal manometry, ambulatory pH studies, antroduodenal manometry, and anorectal manometry. Subspecialty residents will gain exposure to the use and interpretation of scintigraphic gastric emptying, small bowel, and colonic transit studies. Subspecialty residents will observe techniques used for pelvic floor retraining (constipation) and anal sphincter retraining (fecal incontinence). They will be exposed to autonomic function testing and the use of behavioral techniques in the treatment of functional bowel disorders. By the end of the rotation, the subspecialty residents will have an excellent grasp of the evaluation and management strategies in functional bowel disorders and motility disorders. True proficiency requires additional training.

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