Clinical Opportunities

At Tufts Medical Center, fellows rotate on two inpatient consult services: Gastroenterology and Hepatology.

The GI consult service includes both general and advanced GI. Fellows provide inpatient consultative care and manage acute general GI conditions as well as hepatobiliary and advanced endoscopy cases. They take the lead in managing the consult list, coordinating with the endoscopy unit on upcoming procedures and discussing cases with the attending. Fellows also perform all necessary endoscopic procedures for inpatients under supervision.

The hepatology service includes morning multidisciplinary rounds focused on recent post-transplant patients, followed by consultations for general hepatology and advanced liver disease. Fellows work closely with the hepatology attending to evaluate and manage patients with a range of liver conditions. They actively participate in the care of transplant candidates and present these cases at the weekly Liver Transplant Selection Committee. Fellows gain experience caring for hospitalized patients with complications of acute and chronic liver disease, including those in the pre- and post-transplant setting.

Fellows at Tufts Medical Center gain comprehensive experience in endoscopy, from standard procedures such as colonoscopy and esophagogastroduodenoscopy (EGD) to advanced techniques including endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS).

Hands-on training includes advanced mucosal resection and ablation, enteral dilation and stenting, and deep enteroscopy. Fellows with a special interest in endoscopy may also gain exposure to emerging fields such as third space endoscopy, endobariatrics and endohepatology.

Endoscopic expertise at Tufts Medical Center includes:

• Endoscopic mucosal resection of large colon polyps and early cancers, gastric lesions and small intestinal polyps
• Endoscopic full-thickness resection
• Management of dysplastic Barrett’s esophagus and early esophageal cancer with endoscopic mucosal resection and radiofrequency ablation
• Diagnostic and therapeutic ERCP, including biliary and pancreatic stone management, stenting, tissue acquisition, electrohydraulic lithotripsy, endobiliary radiofrequency ablation, cholangioscopy, pancreatoscopy, transpapillary gallbladder drainage for acute cholecystitis and endoscopic papillectomy
• Diagnostic and staging EUS
• Therapeutic EUS including drainage of pseudocysts, walled-off necrosis and abscesses, EUS-guided bile duct and gallbladder drainage, fiducial placement, celiac plexus block and neurolysis, and gastrojejunostomy creation
• Endohepatology procedures such as EUS-guided liver biopsy, portal pressure gradient measurement and treatment of gastric varices
• Enteral stent placement
• Single-balloon enteroscopy
• Third space endoscopy, including endoscopic submucosal dissection, esophageal POEM and gastric POEM
• Endobariatrics, including endoscopic sleeve gastroplasty and transoral outlet reduction

Hepatology

Tufts Medical Center has robust hepatology and liver transplant programs offering deceased liver transplantation.  GI fellows rotate on the inpatient medical liver service throughout their training, and the fellow also participates in the outpatient transplant and hepatology clinics.    Hepatology clinical research opportunities are available.

Inflammatory Bowel Disease

Fellows will learn to manage basic and complex inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, as well as microscopic colitis. Fellows will learn medical management of outpatients, including initiating appropriate biologic therapies and understanding side effects of therapy. Inpatient management will include initiation of acute medical therapies as well as timing of surgical referrals. For fellows wishing to subspecialize in inflammatory bowel disease, there is an opportunity to learn and perform intestinal ultrasound.
Other electives include Colorectal surgery, radiology and pathology and motility and nutrition. 

There are several educational conferences that are offered throughout the fellowship, including:

• Monthly Clinical Pathology Conference
• Monthly clinical case conference
• Morbidity and Mortality Conference
• Liver Tumor Board - monthly
• Didactic rounds – one hour per week, either fellow led or faculty-led
• GI Grand rounds (including noted national and international speakers)
• GI Journal Club
• Medical Grand Rounds
• Boston Intercity Rounds (combined with MGH, Brigham, Lahey Clinic, Beth-Israel and Boston Medical Center)
• Invitation of regional and national guest speakers as well as visiting professors to academic events. 

Core rotations:

• Inpatient GI consult Service: Tufts Medical Center & BMC Brighton
• Inpatient general and transplant hepatology Consult Service
• Outpatient Hepatology Clinics
• Outpatient IBD clinics
• Weekly GI Fellows Continuity Clinic
• Procedure Block at Tufts & BMC Brighton
• Nutrition