Clinical services are provided at UNC Medical Center (900-plus inpatient beds as well as outpatient services), UNC at Meadowmont Endoscopy Center, UNC Eastowne Medical Office Building, UNC Hillsborough Hospital, and UNC Hillsborough Medical Office Building.
In our clinics, we staff more than 20,000 visits, including more than 3,500 new patients each year. In our busy procedure units, we perform more than 20,000 endoscopic procedures each year, including colonoscopies, upper GI endoscopies, ERCPs, EUSs, esophageal dilatations, esophageal manometric studies, sphincterotomies, PEGs, esophageal banding procedures, video capsule endoscopies, and small bowel enteroscopies. Our GI Motility Unit offers esophageal and anorectal manometry, esophageal pH and pH-impedance testing, EndoFLIP, breath testing, and pelvic floor biofeedback.
Luminal Consultation Service
On the Luminal Consultation Service, fellows develop expertise in the diagnosis and management of hospitalized patients with various gastrointestinal illnesses and complaints related to the luminal GI tract. Under the supervision of an attending gastroenterologist, fellows perform consultations and provide follow-up care for inpatients at UNC Medical Center experiencing a variety of GI luminal disorders, including upper & lower GI bleeding, inflammatory bowel disease, functional bowel & motility disorders, dysphagia, abdominal pain, and diarrhea. For continuity of care, fellows perform endoscopic procedures for the patients they see in consultation and provide post-discharge outpatient care for patients who are not already established with another gastroenterology attending, advanced practice provider, or fellow. This service includes two fellows to split consultation responsibilities and maximize continuity of care with endoscopic procedures. In addition, often one or more rotating residents and/or medical students are on the team, which provides extensive opportunities for fellows to hone their cognitive and bedside teaching skills.
Hepatology Consultation Service
On the Hepatology Consultation Service, fellows develop expertise in the diagnosis and management of hospitalized patients with liver diseases. Like the Luminal Consult Service, fellows perform consultations on hospitalized patients at UNC Medical Center. During this rotation, fellows see patients with disorders such as acute liver failure, decompensated liver diseases, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, post-liver transplant complications, abnormal liver enzymes/function tests, and various other conditions. Fellows will also gain primary experience with liver transplant evaluation and listing. For continuity of care, fellows are encouraged to perform endoscopic procedures on these patients, especially in emergency cases. Patients seen in consultation who are not previously seen by a specific GI faculty member or fellow at UNC are subsequently managed by the fellow in continuity clinic should follow-up become necessary. This service typically has one or more rotating residents or medical students on the team, which provides extensive opportunities for fellows to hone their cognitive and bedside teaching skills, and to lead a healthcare team. Fellows on this rotation also participate in liver conferences including liver pathology conference, multidisciplinary hepatobiliary conference and transplant selection conference. In addition to the fellow, this service is supported by an experienced nurse practioner who helps in the coordination and management of care for patients that are immediately pre-transplant and post-transplant.
Biliary/Advanced Endoscopy Consultation Service
On the Biliary/Advanced Endoscopy Consultation Service, fellows gain exposure to advanced therapeutic endoscopy with a focus on pancreaticobiliary procedures. There are typically two advanced endoscopy attendings performing procedures in the Main endoscopy unit daily. Procedures include ERCP, diagnostic EUS, therapeutic EUS (including gastrojejunostomy, hepaticogastrostomy, EDGE, gallbladder drainage), endoscopic stenting, and placement of percutaneous jejunostomy tube. In addition, there are opportunities to gain exposure to advanced endoscopic resection and third-space endoscopy (POEM). The service is supported by an experienced nurse practitioner who splits consultations with the fellow and helps to coordinate outside procedure requests. The 4th-year Advanced Endoscopy fellow helps to support the service as well.
The Ambulatory Rotations are one of the unique features of the UNC GI & Hepatology Fellowship Program. During the Ambulatory Rotations, fellows spend half-days rotating through our numerous sub-specialty programs in our centers of excellence, working alongside expert faculty in inflammatory bowel disease, esophageal diseases, functional bowel disorders, motility disorders, and hepatology. Within these clinics, fellows get experience seeing tertiary and quaternary care referrals while working with world-renowned experts, such as Hans Herfarth (IBD) and Nick Shaheen (esophageal disease). During ambulatory time, fellows also have exposure to the work up of urgent outpatient referrals in a weekly urgent clinic as well as weekly continuity clinic.
Ambulatory Hepatology Rotation
The Ambulatory Hepatology rotation provides fellows with exposure to outpatient management of pre- and post-transplant patients, diagnostic work up of abnormal LFTs, management of liver masses, and outpatient management of chronic and end stage liver disease. Fellows on this rotation also have exposure to outpatient endoscopic procedures in patients with liver disease, including endoscopic procedures for varices. Faculty are experts in general and transplant hepatology, viral hepatology, fatty liver disease, autoimmune liver disease and liver cancer. Fellows on this rotation also participate in liver conferences including liver pathology conference, multidisciplinary pancreatobiliary conference and transplant selection conference.
During Endoscopy Rotations (at UNC Memorial, UNC at Meadowmont and UNC Hillsborough), fellows receive dedicated training in both the cognitive and procedural aspects of endoscopy. Under faculty supervision, fellows learn the skills needed to perform diagnostic, screening, and surveillance upper endoscopy and colonoscopy, as well as therapeutic aspects of the endoscopy, such as mucosal biopsy, polypectomy, hemostasis, variceal banding, stricture dilation, and gastrostomy tube placement. They will also have exposure to more advanced procedures including therapeutic and diagnostic ERCP, EUS, and endoscopic jejunostomy tube placement. Our endoscopy unit at Meadowmont is higher-volume and runs on a schedule similar to an ASC, allowing 2nd and 3rd year fellows to hone their endoscopic skills with a particular focus on screening colonoscopy.
Throughout training, GI fellows longitudinally manage outpatients with various gastrointestinal illnesses in their own continuity clinic. Although continuity clinic is supervised by a GI faculty member, fellows assume the role of primary GI physician for these patients through the course of their illness. In continuity clinic, fellows typically see 2 to 3 new patients and 3 to 4 return patients per session. Continuity clinics are at both our UNC Hillsborough and UNC Eastowne locations. One particularly attractive feature of our program’s continuity clinic is the ability to spend part of the last years of the fellowship program within one of the subspecialty clinics to allow fellows to tailor their training for their personal career goals.
This rotation is a hybrid rotation, including both outpatient endoscopy cases (with conscious sedation) and inpatient consults at the UNC Hillsborough Hospital. Typically, fellows perform up to 8 procedures a day and do 1-3 inpatient consults. The cases at this unit are often primary referrals, typically general cases that would often be seen in a community hospital setting. During this rotation, fellows hone consultative and endoscopy skills needed for community gastroenterology practice. There is also the opportunity to do inpatient endoscopy cases when needed in the hospital.
Aside from the core rotations noted above, fellows may also do elective rotations in motility, nutrition, esophageal disease, inflammatory bowel disease, and advanced endoscopic resection (EMR/ESD/Third Space Endoscopy). Other elective rotations can be facilitated after discussion with the program director. Most rotations are 2 weeks long.
The following didactic conferences complement direct patient care experiences:
- Core Curriculum Conference
- GI Grand Rounds
- Journal Club
- CGIBD Research Seminar
- GI Epidemiology Conference
- Hepatobiliary Conference
- Liver pathology conference
- Functional GI conference