Advanced Endoscopy Training

Since 1994, MUSC Digestive Health (formerly known as the Digestive Disease Center) has offered one-year programs for advanced training (under the umbrella of our ACGME-accredited fellowship program), focusing on highly technical procedures such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). Currently, this combined advanced endoscopy fellowship (AEF) training is offered by the Department of Medicine, Division of Gastroenterology and Hepatology, MUSC Digestive Health.

Members of the MUSC Division currently perform more than 1,000 EUS and 600 ERCP procedures each year. The number of ERCPs is likely to increase substantially with additional expert faculty that started in July 2014.

Hands-On Training

G. I. Fellow observing physician demonstrating an EUS procedure. A typical AEF trainee will be hands-on for about 250 ERCP (over seven months) and 300 EUS (over four months). Very advanced maneuvers such as ductoscopy, electrohydraulic lithotripsy (EHL), ampullectomy, pseudocyst drainage, and even EUS-guided duct drainage procedures are available for those who have, or are able to acquire, an acceptable skillset to do these procedures safely.

Mucosal resections (EMR) and ablation (RFA, cryotherapy) are available during the EUS portions of the training, and several of these are done each week. Training in advanced mucosal/epithelial imaging, including probe-based confocal endomicroscopy is available. Single-balloon enteroscopy and luminal self-expandable metal stents are performed regularly, and exposure to these is available as time permits. A half-day per week throughout the year (with the exception of the attending month) is reserved as a scope- and patient-free day that must be used for research.


Achieving acceptable competence in both ERCP and EUS in a single year is challenging. Preference will be given to candidates whose applications demonstrate completion of (or plan to complete) a significant volume of one, or ideally both, of these procedures in regular fellowship (or in post-fellowship practice).

We receive many applications for these positions and have made a decision to focus training on those who plan to become trainers themselves. As such, a demonstrated ongoing commitment to academics, and a well-thought-out career plan are important to our selection process.

Advanced Trainees typically come to MUSC for one year (although occasionally for longer), starting in July. The position is currently open only for candidates with permanent resident status (to permit a temporary faculty appointment). The current mentors are Drs.:

Dr. Peter B. Cotton participates and mentors in research in these areas.

The successful applicant will be recommended for an appointment to a junior faculty position ("Clinical Instructor") with a PGY7 salary, and is expected to (i) provide general GI attending services for one month of the year, (ii) to supervise the fellows' clinic on one afternoon each week throughout the year, and (iii) to participate in the attending call pool (one in 8-10).Completion of an original research manuscript (excluding case study/series) is required to obtain a certificate of completion of the program.

Non-USA Citizens or Residents

Graduates without citizenship or permanent US residency status (from USA or overseas) are sometimes accepted when space is available. They are not eligible for faculty and are appointed as "advanced fellows", and usually for ERCP or EUS (but not both). Passing scores on the USMLE are essential. Funding is a challenge and addressed on an individual basis. Candidates with their own funds (or partial support) are preferred. Because of paperwork hurdles, there are no time rules for application, but we usually start about two years ahead and use the same application form. The scope of training is individualized.

For More Information

Further details are available from the AEF Program Director, Brenda Hoffman ( or her administrative assistant, Louise Jones ( or 843-876-4265.