MUSC Advanced Endoscopy Fellowship 2011: Prof. Jonathan Brown

Medical school: The Ashley river tower accommodates the gastroenterology and cardiology divisions of the Medical University of South Carolina. This is an imposing building that is only 4 years old. The GI offices are on the 7th floor with views over the town and river. The endoscopy rooms are on the 2nd floor.

Academic content: This comprised exposure to the business and administration departments of the GI section of the medical school, almost daily ERCP and EUS opportunities, lecture theatre based departmental teaching, research in progress and case presentations, ward rounds, motility, histopathology and radiology meetings.

Endoscopy facilities: Half of the second floor of the Ashley river tower is dedicated to endoscopy and there are multiple suites that have x-ray screening facilities and cytology/microscopy equipment for rapid tissue diagnosis. In one theatre I counted 17 video monitors and it was gratifying to see a corner-mounted “situational awareness” screen which provided all theatre staff with an overview of the case and fostered a team sense of involvement.

Research: We attended a research in progress meeting presented by the fellows. The focus was on the clinical practice of endoscopy with an emphasis on ERCP and EUS. Peter Cotton is leading an NIH funded multi-centre study [Evaluating Predictors & Interventions in Sphincter of Oddi Dysfunction (EPISOD)] in patients with SOD III. The primary study objective is to determine whether subjects satisfying the entry criteria respond to sphincterotomy and it is a is a two-arm parallel, randomized, double-blinded, sham-controlled (2:1 in favour of sphincterotomy) study. The trial will close in 5 years and should provide us with the following answers -

  • the association between the results of Sphincter of Oddi Manometry (abnormal/normal) and the primary outcome (success/failure)
  • the success rate of subjects who receive biliary sphincterotomy alone versus subjects who receive both biliary and pancreatic sphincterotomy in the subgroup of patients with manometrically proven hypertension of the pancreatic sphincter
  • the effects of pre-specified prognostic factors on the primary outcome
  • anxiety and depression scores over time and their relation to study outcomes
  • the economic impact of SOD III, and of endoscopic sphincterotomy in patients with SOD III