SFVA Division of Gastroenterology

About                                           UCSF GI

The San Francisco VA GI Division provides GI specialty care to veterans throughout northern California. We offer the full spectrum of gastroenterology and hepatology diagnostic and therapeutic services, and are deeply committed to providing the highest quality care to our Veterans.

GI waiting roomPatients are evaluated in outpatient clinic appointments, inpatient consultations and, in appropriate cases, video telehealth and electronic consultations. We staff a gastrointestinal procedures unit on site at the San Francisco VA for routine and advanced diagnostic and therapeutic endoscopy. The SFVA GI Division is a center of excellence in advanced endoscopy, inflammatory bowel disease, and chronic liver disease. In addition to clinical excellence, we are committed to promoting excellence in academics through our research and educational endeavors. 

Faculty

We are fortunate to have faculty with diverse interests and expertise that allow us to serve as a tertiary care referral practice within our VISN.

The SFVA is a center of excellence in advanced endoscopy, inflammatory bowel disease, and chronic liver disease. Our faculty hold leadership positions in our national GI societies, serve on the US Multi-Society Task Force on Colorectal Cancer, have served on society practice guideline committees, and on the editorial board of Gastrointestinal Endoscopy. 

Education                  GI Fellowship

The SFVA is one of three primary teaching sites for the University of California, San Francisco Gastroenterology Fellowship. Each month, we have three fellows rotating with us on clinical rotations.  The fellows participate in outpatient GI and liver clinics, outpatient GI procedures, inpatient consultation, and inpatient emergency care.

We have designed an endoscopic curriculum to enhance the learning of critical endoscopy skills throughout the GI fellowship program, with the goal of graduating fellows who can adeptly perform diagnostic and therapeutic endoscopy for the whole spectrum of GI disorders. The focus for first year fellows is optimizing acquisition of basic endoscopy skills. First year fellows are first introduced to endoscopy through a series of lectures on basic concepts such as indications and contraindications to endoscopic procedures, and to the process of informed consent. Then a common endoscopic vocabulary is introduced, as well as realistic goals for early fellowship training. First year fellows complete a hands-on training session practicing setting up endoscopes and basic maneuvers using a simulator.  The senior fellow (second and third year GI fellow) curriculum focuses on understanding quality metrics for colonoscopy and developing advanced diagnostic and therapeutic skills. The curriculum consolidates high-yield articles, web-based videos, and videos from our learning library into weekly themes. The fellows are required to complete the readings and video training modules, and demonstrate competency to a faculty member at the end of the week. Weekly themes include understanding the pathological correlate to endoscopic findings, screening and surveillance guidelines (for Barrett’s, colon cancer, IBD etc.), optimizing detection and optical characterization of lesions through digital and surface chromoendoscopy, role of endoscopic ultrasound and ERCP, advanced polypectomy techniques, and treatment of endoscopic complications. At the SFVA, we are fortunate to have attendings with both the expertise and the passion to train the next generation of endoscopists.

Patient Care

SFVA GI Clinic x23328Campus cactus

SFVA GI Procedures x23348

SFVA Liver Clinic x24771

Research

The SFVA faculty are active in basic science, clinical and translational research. Research is supported by VA merit awards, RO1s, VA innovations grants, GI society grants, and gifts from industry. Areas of focus include:

Liver disease
  • The role of natural killer cell receptor-ligand polymorphisms on hepatitis associated clinical outcomes
  • Optimizing Hepatitis C therapies and predicting disease outcomes in a prospective cohort of HCV positive veterans
  • Natural history of HCC in the era of direct acting antivirals
  • Impact of HCV therapies on neuropathogenesis of HIV/HCV co-infection and HCV mono-infection
IBD
  • The role of innate immune signaling intermediates in the pathogenesis of human inflammatory bowel disease.
  • Optimizing the quality of endoscopy and neoplasia surveillance in inflammatory bowel disease
Quality in endoscopy
  • Creation of a national VHA report card for quality in colonoscopy
  • Use of a HIPAA compliant patient engagement platform to improve bowel prep quality
Education
  • The role of terminal video feedback as compared to conventional concurrent feedback on cold snare polypectomy technique in trainees.
  • Participating in a multi-site study evaluating trainee competency and learning curves for upper endoscopy and colonoscopy
  • Developing, in partnership with VHA Specialty Care Center for Innovation & the National Gastroenterology Program Director, a National Training Program for VHA endoscopists through the VHA SimLEARN National Simulation Center.
Ergonomics in endoscopy

Understanding, in partnership with the UC Ergonomics Research and Graduate Training Program, the biomechanical risk factors associated with the performance of colonoscopy and evaluating tools and techniques to reduce risk