Advanced Endoscopy Research in Calgary

The advanced endoscopy group in Calgary has exploded over the past several years in terms of novel clinical expertise, research productivity, education, and overall impact. Several physicians in Calgary offer advanced endoscopic techniques beyond those associated with basic endoscopy (gastroscopy and colonoscopy). Examples of advanced endoscopic procedures include endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), endoscopic submucosal dissection (ESD), complex luminal stenting, and endoscopic mucosal resection (EMR).

The clinical catchment area for Calgary’s advanced endoscopy program approaches 2 million residents across southern Alberta and Eastern British Columbia. The keys to the program’s success to date have been the seamless integration of a high-throughput research program and high-quality clinical fellowship into an established clinical service with high standards of care.

Ucalgary is leading the Canadian landscape in clinical fellowship training in Advanced Endoscopy. Ucalgary’s model is unique, offering trainees the opportunity to complete a clinical fellowship alongside a graduate degree in health research methodology (most commonly through the Department of Community Health Sciences) in 2 years. Given a typical average of 40-50 applicants from across the world for 1-2 annual positions, the fellowship programs have recently been subdivided into an advanced pancreaticobiliary endoscopy training program and an advanced luminal endoscopy and deep tissue resection training program. Nauzer Forbes has been the fellowship program director for the advanced pancreaticobiliary endoscopy program since 2018, with Paul Belletrutti recently having taken over as program director of the luminal program. The priority of both streams is to train individuals both as outstanding clinicians/endoscopists and potential future academics. By offering simultaneous research training and protecting trainees’ time for academic productivity, interest in research is fostered, as is academic output for Ucalgary.

Much of the success of UCalgary’s advanced endoscopy research program relates to CReATE, a unique prospective multi-center advanced endoscopy research collaborative that is now operational at 9 centres across Canada, USA, and Europe. Nearly 7,000 patients have been enrolled in CReATE, with over 400 granular variables collected per procedure in real time. Nauzer Forbes, as CReATE’s PI, has successfully leveraged internal funding, including through the N.B. Hershfield Chair in Therapeutic Endoscopy (with Steve Heitman occupying the Chair), to launch and expand CReATE. He has since been successful at obtaining external funding for CReATE-related research, including multiple project grants from the Canadian Institutes of Health Research and awards from the American College of Gastroenterology and American Society for Gastrointestinal Endoscopy (ASGE). Thus, via the initial modest commitment of internal funds, the program has raised over $3M in external support towards research.

Ucalgary’s research program is widely recognized for its methodologically rigorous and impactful work in advanced endoscopy, including the recent publication of a multi-centre randomized trial on ERCP-related outcomes in JAMA Internal Medicine^[1]. Other important research works have been disseminated from the group on ERCP adverse events and patient-reported outcome measures, among others.^[2],[3] Importantly, Nauzer Forbes also continues to serve on the ASGE’s Standards of Practice Committee since 2020, meaning that UCalgary has a recognized impact on broadly disseminated guidelines from the world’s largest endoscopy society. 

Several other internationally recruiting prospective studies and trials in advanced endoscopy are underway at UCalgary. The recent returns of Drs. Puja Kumar and Paul Belletrutti from world-renowned sabbaticals in advanced tissue resection and the recent recruitment of Dr. Suqing Li, an advanced endoscopist with interests in translational medicine, together herald a new era in UCalgary’s clinical and research programs. Building off their existing research infrastructure, the group is poised to continue toward their goal of having UCalgary recognized as a world-class clinical and academic centre for advanced endoscopy.

 

^{References
1) Forbes N, Elmunzer BJ, Allain T, et al. Effect of Disposable Elevator Cap Duodenoscopes on Persistent Microbial Contamination and Technical Performance of Endoscopic Retrograde
Cholangiopancreatography: the ICECAP Randomized Clinical Trial. JAMA Int Med 2023;183:191-200.
2) Forbes N, Elmunzer BJ, Keswani RN, et al. Consensus-based Development of a Causal Attribution System for Post-ERCP Adverse Events. Gut 2022; online ahead of print.
3).Forbes N, Chau M, Koury HF, et al. Development and Validation of a Patient-reported Scale for Tolerability of Endoscopic Procedures Using Conscious Sedation. Gastrointest Endosc 2021;94:103-110.}