Esophageal and gastric variceal bleeding caused by portal hypertension is a common and severe disease in cirrhosis, with an incidence rate of more than 50%, and a mortality rate of more than 20%. The endoscopic ultrasound-guided selective varices devascularization (EUS⁃SVD), a novel and effective therapeutic method for varices, was first proposed by us in 2018 and was listed as one of the“latest clinical technological breakthroughs”by the 2019 Digestive Disease Week (DDW).

EUS-SVD has now been routinely used in the primary prevention, secondary prevention and emergency hemostasis of patients with esophageal and gastric varices in our center. A large clinical cohort study of more than 1000 cases was followed up for more than 5 years in our center and showed satisfactory results in controlling rebleeding.

The EUS-SVD Fellowship Program in the First Affiliated Hospital of Zhejiang University School of Medicine provides a unique environment for exceptional candidates to pursue advanced training in managing gastroesophageal varices and isolated gastric varices using EUS-SVD.

This program is open to all fellows, residents and medical students. We firmly believe that during your training, your responsibilities increase with your experience, capability, and performance. You will become highly skilled in the multi-disciplinary management of gastroesophageal varices and isolated gastric varices, and gain extensive experience with the clinical and research tools needed for a successful academic career in this field.

1. Having many opportunities to learn about and perform EUS-SVD in managing gastroesophageal varices and isolated gastric varices in a one-on-one setting with our endoscopists.

2. Having direct access to faculty members who, in addition to caring for patients in their clinical practices, are committed to teaching and facilitating the growth of medical knowledge.

3. Participating in literature/guidelines learning and rounds each morning as part of a small team. During rounds, new patients are presented, inpatient management is reviewed, and teaching sessions are held.

4. Outstanding research opportunities. Our faculty members are recognized leaders in their fields, and our center has a complete supporting laboratory and a biological sample bank.

5. Participating in the daily morning difficult cases discussion meeting, and monthly multidisciplinary treatment meeting.

The goal of our program is to prepare trainees to achieve excellence in the multidisciplinary clinical management of patients with simple and complex cirrhotic portal hypertension. And to know and understand the operation of EUS-SVD in the treatment of variceal bleeding. For advanced trainees, the goal is to master the procedures of EUS-SVD and can carry out the treatment independently after back to their center. We also aim to provide our advanced trainees with a strong foundation in clinical investigation to launch them into successful careers in academic medicine. Dedicated research time and resources will allow our trainees to develop and execute independent research projects with the appropriate mentorship.

The program provides a full-time, 2-week to 6-month training experience. In special circumstances, arrangements can be made for other lengths of training depending on your needs and interests.

• Fellows: Qualified applicants for this advanced Endoscopic Fellowship must have completed an endoscopic program at an accredited institution.

• Residents: To be eligible for the endoscopic residency, you must have successfully completed a board-approved program in internal medicine at an accredited institution.

• Students:

1. Must be a final-year medical student when you are scheduled to participate in the rotation. This means all your core/required clerkship rotations are complete at the time of the clinical elective.

2. Medical School Approval - Letter of good standing from the dean's office of your medical school indicating you are in the final year with your expected graduation date, in good academic standing and meet all requirements to complete an elective for academic credit. 

Focus Areas & Subspecialties:

1. Decompensated cirrhosis and complications

2. Portal hypertension

3. Acute variceal bleeding

4. Pancreatitis

5. Pancreatic carcinoma

6. Cholangiocarcinoma and gallstones

7. Early GI cancers (esophageal, gastric, duodenal, colonic and rectal)

8. Inflammatory bowel disease

9. Functional gastrointestinal disorders

10. Gastrointestinal motility diseases

11. Multidisciplinary team management in GI bleeding

Skills:

1. Basic devices: endoscopy, ultrasound-endoscopy, capsule endoscopy, etc.

2. Basic surgical skills: EMR, ESD, EFR, STER, POEM, ERCP, etc.

Monday

1st Week: introduction & welcome, program overview and objectives, department introduction

Weekly: MDT conferences, complicated case study

Weekly: Mentor one-on-one training:

-Topics:

1. GI bleeding

2. Portal hypertension

3. Acute pancreatitis

4. Biliary & pancreatic disease

5. Endoscopy (including EUS, capsule endoscopy, ERCP, etc.)

Tuesday

Weekly: outpatient observation, academic lecture, basic endoscopic skills training

biweekly: research training:

-Major themes:

1. Risk assessment

2. Prevention and early screening

3. Early detection

4. Endoscopic interventions

Wednesday

Weekly: clinical rounds, advanced endoscopic procedures observation, case-based discussion, teaching rounds

Biweekly: endoscopic training

Weekly: Lectures:

-Topics:

1. Liver disease imaging interpretation

2. Diagnoses and management of pancreatic cystic disease

Thursday

Weekly: endoscopic skills training:

1. Operation of EUS, Collecting EUS pictures, Identifying the scanning site;

2. EUS-guided puncture, aspiration, injection

Biweekly: EUS intervention hands-on

Friday

Weekly: journal club, clinical rounds, clinical skills training, special task training,

Last week: wrap-up & reflection, participant presentations or discussion of key takeaways, feedback session

After each rotation, each faculty member evaluates each fellow according to core competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and system-based practice. Faculty members meet with fellows individually for verbal feedback and evaluation. For endoscopy, technical competence is evaluated through specifically designed evaluation forms, a simulator laboratory, and through a semiannual skills assessment program. Monthly, an aggregate evaluation of a fellow's clinical progress is conducted through a clinical competency faculty committee.

The program is free of charge.