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Clinical services are provided at UNC Medical Center (900-plus inpatient beds as well as outpatient services), UNC at\u202f<\/span>Meadowmont<\/span> Endoscopy Center, UNC <\/span>Eastowne<\/span> Medical Office Building, UNC Hillsborough Hospital, and UNC Hillsborough Medical Office Building.<\/span><\/span>\u00a0<\/span><\/p>\n In our clinics,\u202fwe staff more than 20,000 visits, including more than 3,500 new patients each year. In our busy procedure units, we perform more than <\/span>20,000<\/span> 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\u202f<\/span>enteroscopies<\/span>.\u202f<\/span>Our<\/span> GI Motility Unit offers esophageal and anorectal manometry, esophageal <\/span>pH<\/span> and pH-impedance testing, <\/span>EndoFLIP<\/span><\/span>,<\/span><\/span>\u202fbreath testing, and pelvic floor biofeedback.<\/span><\/span>\u00a0<\/span><\/p>\n On the Luminal Consultation<\/span><\/span>\u202f<\/span><\/span>Service, fellows develop <\/span>expertise<\/span> 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 <\/span>consultations<\/span> and<\/span> provide<\/span> 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, <\/span>fellows perform<\/span> endoscopic procedures for the<\/span> patients<\/span> they see in consultation<\/span> and provide post-discharge outpatient care for patients who are not already <\/span>established<\/span> with <\/span>another gastroenterology<\/span> attending, advanced practice provider, or fellow. This service\u202fincludes two fellows<\/span> to split consultation responsibilities and maximize continuity of care with endoscopic procedures.<\/span> In <\/span>addition, often<\/span> one or more rotating residents and<\/span>\/or<\/span> medical students <\/span>are <\/span>on the team, which <\/span>provides<\/span> extensive opportunities for fellows to hone their cognitive and bedside teaching skills.<\/span><\/span>\u00a0<\/span><\/p>\n On the Hepatology Consultation Service, fellows develop <\/span>expertise<\/span> 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. <\/span>Fellows will also gain primary experience with liver transplant evaluation and listing. <\/span>For continuity of care, fellows are encouraged to <\/span>perform <\/span>endoscopic<\/span> procedures on thes<\/span>e<\/span> patients, <\/span>e<\/span>specially in emergency cases. <\/span>Patients seen in consultation who are not previously seen by a specific GI faculty membe<\/span>r or <\/span>fellow <\/span>at UN<\/span>C are <\/span>subsequently<\/span> managed by the fellow<\/span> in cont<\/span>i<\/span>nuity clinic should follow-up become necessary. This service typically has one or more rotating residents or medical stude<\/span>nts o<\/span>n t<\/span>he te<\/span>am, which <\/span>provid<\/span>es<\/span> extensiv<\/span>e opportunities for fellows to hone their cognitive and bedside teaching skil<\/span>ls, and to lead <\/span>a healthcare tea<\/span>m.\u202f<\/span>Fellows<\/span> on t<\/span>his ro<\/span>tatio<\/span>n also <\/span>participate<\/span> in liver conferences including liver pathology conference, multidisciplinary\u202f<\/span>h<\/span>epato<\/span>biliary <\/span>conference<\/span> and transplant selection\u202f<\/span>conference.<\/span> In additi<\/span>o<\/span>n to the f<\/span>e<\/span>llow<\/span>,<\/span> this ser<\/span>v<\/span>ice is su<\/span>p<\/span>ported b<\/span>y<\/span> an <\/span>exper<\/span>ience<\/span>d nurse <\/span>practioner<\/span> who helps in the coordination and management of care<\/span> for <\/span>patien<\/span>ts th<\/span>at ar<\/span>e <\/span>imm<\/span>ediat<\/span>ely<\/span> p<\/span>re-<\/span>tr<\/span>ansp<\/span>l<\/span>ant<\/span> a<\/span>nd post-<\/span>transplant<\/span>.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n On the<\/span> Biliary\/A<\/span>dvanced Endoscopy Consultation Service, fellows gain exposure to advanced therapeutic endoscopy with a focus on pancreaticobiliary procedures. <\/span>There are typically two advanced endoscopy attendings performing procedures in the Main endoscopy unit daily. Procedures include ER<\/span>CP, diagn<\/span>ostic EUS, therapeutic EUS (including gastrojejunostomy, <\/span>hepaticogastrostomy<\/span>, EDGE, gallbladder drainage), endoscopic stenting, and placement of percutaneous jejunostomy tube. <\/span>In addition, there are opportunities to gain exposure to advanced endoscopic resection and third-space endoscopy (POEM). <\/span>The service is supported by an <\/span>experienced<\/span> nurse practitioner who <\/span>splits<\/span> consultations with the fellow <\/span>and helps to coordinate outside procedure requests.<\/span> T<\/span>he 4<\/span><\/span>th<\/span><\/span>-year Advanced Endoscopy fellow helps to support the service as well<\/span>.\u00a0<\/span>\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n The Ambulatory Rotation<\/span>s<\/span> are<\/span> one of the unique features of the UNC GI & Hepatology Fellowship Program.<\/span> During the Ambulatory Rotation<\/span>s<\/span>, fellows spend half-days rotating through our <\/span>numerous<\/span> sub-specialty programs\u202fin our centers of excellence, working alongside expert faculty in inflammatory bowel disease, esophageal diseases, functional bowel disorders, motility disorders,<\/span> and<\/span> hepatology<\/span>. Within these clinics, fellows get experience seeing tertiary and quaternary care referrals while working with world-renowned experts, such as Hans <\/span>Herfarth<\/span>\u202f(IBD)\u202fand Nick <\/span>Shaheen<\/span> (esophageal disease). <\/span>During ambulatory time, fellows also have exposure to\u202fthe work up of\u202furgent\u202foutpatient referrals\u202fin a weekly urgent clinic<\/span> as well as weekly continuity clinic<\/span>.<\/span><\/span>\u00a0<\/span><\/p>\n The Ambulatory Hepatology rotation provides fellows with exposure to outpatient management of\u00a0pre- and\u00a0post-transplant\u00a0patients, diagnostic work up of abnormal LFTs,\u00a0management of liver masses, and\u00a0outpatient management of chronic\u00a0and end stage\u00a0liver disease.\u00a0Fellows on this rotation also have exposure to outpatient endoscopic procedures in patients with liver disease, including endoscopic procedures for varices.\u00a0Faculty are experts in\u00a0general and transplant\u00a0hepatology, viral\u00a0hepatology, fatty liver disease, autoimmune liver disease and liver cancer.\u00a0Fellows on this rotation also participate in liver conferences including liver pathology conference, multidisciplinary\u00a0pancreatobiliary\u00a0conference and transplant selection\u00a0conference.<\/p>\n During\u202fEndoscopy Rotations\u202f(at UNC Memorial, UNC at\u202f<\/span>Meadowmont<\/span>\u202fand UNC Hillsborough), fellows receive dedicated training in both the cognitive and procedural aspects of endoscopy. <\/span>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\u202fmucosal biopsy, polypectomy, hemostasis, <\/span>variceal banding, <\/span>stricture dilation, and gastrostomy tube placement.<\/span> They will also have exposure to more advanced procedures including therapeuti<\/span>c and diagnostic ERCP<\/span>, <\/span>EUS<\/span>, and e<\/span>ndoscopic jejunostomy tube placement<\/span>. <\/span>Our endoscopy unit at Meadowmont is higher-volume and runs on a schedule <\/span>similar to<\/span> an ASC, allowing 2<\/span><\/span>nd<\/span><\/span> and 3<\/span><\/span>rd<\/span><\/span> year fellows to hone<\/span> their endoscopic skills<\/span> with a particular focus<\/span> on screening colonoscopy.<\/span>\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n Throughout training, GI fellows longitudinally manage outpatients with various gastrointestinal illnesses in their own continuity clinic.\u00a0<\/span> 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.<\/span> In continuity clinic, fellows typically see 2 to 3 new patients and\u202f3 to 4\u202freturn patients per session.\u202fContinuity clinics are at both our UNC Hillsborough and\u202fUNC\u202f<\/span>Eastowne<\/span>\u202flocations.\u202fOne particularly attractive feature of our program\u2019s continuity clinic is the ability to spend\u202fpart 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.<\/span><\/span>\u00a0<\/span><\/p>\n This rotation is a hybrid rotation, including both outpatient endoscopy cases\u202f(with conscious sedation)\u202fand inpatient consults at the UNC Hillsborough Hospital.\u202fTypically, fellows perform up to 8 procedures a day and do 1-3 inpatient <\/span>consults<\/span>.\u202f\u202fThe cases at this unit are often primary referrals,\u202ftypically\u202fgeneral cases that\u202fwould often be seen\u202fin a community hospital setting. During this rotation, fellows hone consultative and endoscopy skills needed for community gastroenterology practice.\u202fThere is also the opportunity to do inpatient\u202fendoscopy\u202fcases when needed in the hospital.<\/span><\/span>\u00a0<\/span><\/p>\n Aside from the core rotations noted above, fellows may also do elective rotations in motility<\/span>, nutrition,<\/span> esophageal disease,<\/span> inflammatory bowel disease, <\/span>and <\/span>advanced endoscopic resection (EMR\/ESD<\/span>\/Third Space Endoscopy<\/span>)<\/span>.<\/span> Other<\/span>Luminal Consultation Service<\/h2>\n
Hepatology Consultation Service<\/h2>\n
Biliary\/Advanced <\/span>Endoscopy<\/span> Consultation Service<\/span><\/span>\u00a0<\/span><\/h2>\n
Ambulatory Rotation<\/h2>\n
Ambulatory Hepatology Rotation<\/h2>\n
Endoscopy Rotations<\/h2>\n
Continuity Clinic<\/h2>\n
Hillsborough Rotation<\/h2>\n
Elective Rotations<\/h2>\n