Faculty Bibliography

BACKGROUND: The number of applications to advanced endoscopy fellowships has increased in past years. There is limited knowledge regarding why gastroenterology fellows pursue interventional/advanced endoscopy (AE) as a career. OBJECTIVE: To explore the characteristics, goals, and motivations of applicants applying for AE fellowships. DESIGN: A total of 101 applicants of the 2011 AE fellowship match were sent a survey via electronic mail 4 weeks after the match. PARTICIPANTS: A total of 65 applicants participated. INTERVENTION: Study questionnaire. RESULTS: The response rate was 64.4% (95% certainty +/- 5%). By the first year of gastroenterology fellowship, 67% had decided to apply for an AE fellowship. Half stated that pursuing a career in AE was a difficult decision; primary concerns included the additional year of training and the delay in income. A total of 69% of applicants intended to pursue academics. Applicants listed endoscopic procedures (92%), exposure to mentors in the field (46%), and demand for the skill set (43%) as the most significant sources of motivation in pursuing AE. Influential factors in an applicant's decision to choose a program included high procedure volume (69%), reputation of the program (63%), and a desirable geographic location (61%). Applicants who reported difficulty in choosing AE as a career were less inclined to pursue academia as compared with those with no difficulty deciding (54.8% vs 84.4%; P = .006). These same applicants were similarly less motivated to pursue research (3.1% vs 34.3%; P = .002). Applicants who favored academia versus private practice listed mentors in the field (54% vs 25%; P = .031) and research interest (27.3% vs 0%; P = .012) as significant factors. LIMITATIONS: One-year sample of applicants. CONCLUSION: Although a majority of applicants decided to pursue careers in AE during the first year of gastroenterology fellowship, making the decision was difficult for half of the applicants. Motivations for choosing AE as a career differed among applicants interested in academics versus private practice.

BACKGROUND: The diagnosis of indeterminate biliary strictures is limited because of the low sensitivity of cytology. However, an accurate diagnosis of malignancy is critical in the management of patients with suspected biliary malignancy. Testing for chromosomal aneuploidy by fluorescence in situ hybridization (FISH) may increase the yield. OBJECTIVE: To evaluate the diagnostic accuracy of FISH in indeterminate biliary strictures and the additional value of including deletion of 9p21 (p16) in the diagnostic criteria of malignant biliary strictures. DESIGN: Retrospective review. SETTING: Academic medical center. PATIENTS: This study involved 76 consecutive patients who were seen for the evaluation of indeterminate strictures at our institution. These patients were screened, and 50 patients with either a final pathologic diagnosis or >/= 12 months' conclusive follow-up were included in the analysis. MAIN OUTCOME MEASUREMENTS: Sensitivity, specificity, and area under the curve (AUC) analysis of cytology alone compared with the presence of FISH polysomy versus FISH polysomy and 9p21 deletion. RESULTS: The presence of increased copy numbers (polysomy) of chromosome 3, 7, or 17 by FISH increased the sensitivity of brush cytology from 21% to 58%, and when the presence of 9p21 deletion was included, the sensitivity increased to 89%. The specificity of FISH was 97% (vs 100% for cytology). The accuracy of cytology combined with FISH polysomy (AUC = 0.93) or p16 deletion was significantly greater than the accuracy of cytology alone (AUC 0.6; P < .001) or even cytology combined with FISH polysomy (AUC = 0.77; P