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The advanced endoscopy group in Calgary hasÌýexploded over the past several years in terms of novelÌýclinical expertise, research productivity, education,Ìýand overall impact. Several physicians in Calgary offerÌýadvanced endoscopic techniques beyond those associatedÌýwith basic endoscopy (gastroscopy and colonoscopy).ÌýExamples of advanced endoscopic proceduresÌýinclude endoscopic retrograde cholangiopancreatographyÌý(ERCP), endoscopic ultrasound (EUS), endoscopicÌýsubmucosal dissection (ESD), complex luminal stenting, and endoscopic mucosal resection (EMR).

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

Ucalgary is leading the Canadian landscape in clinicalÌýfellowship training in Advanced Endoscopy. Ucalgary’sÌýmodel is unique, offering trainees the opportunity toÌýcomplete a clinical fellowship alongside a graduateÌýdegree in health research methodology (mostÌýcommonly through the Department of CommunityÌýHealth Sciences) in 2 years. Given a typical averageÌýof 40-50 applicants from across the world for 1-2Ìýannual positions, the fellowship programs have recentlyÌýbeen subdivided into an advanced pancreaticobiliaryÌýendoscopy training program and an advanced luminalÌýendoscopy and deep tissue resection training program.ÌýNauzer Forbes has been the fellowship programÌýdirector for the advanced pancreaticobiliary endoscopyÌýprogram since 2018, with Paul Belletrutti recently havingÌýtaken over as program director of the luminal program. The priority of both streams is to train individuals bothÌýas outstanding clinicians/endoscopists and potentialÌýfuture academics. By offering simultaneous researchÌýtraining and protecting trainees’ time for academic productivity,Ìýinterest in research is fostered, as is academicÌýoutput for Ucalgary.

Much of the success of Áù¾ÅÉ«Ìà advancedÌýendoscopy research program relates to CReATE, aÌýunique prospective multi-center advanced endoscopyÌýresearch collaborative that is now operational at 9Ìýcentres across Canada, USA, and Europe. Nearly 7,000Ìýpatients have been enrolled in CReATE, with over 400Ìýgranular variables collected per procedure in real time.ÌýNauzer Forbes, as CReATE’s PI, has successfullyÌýleveraged internal funding, including through the N.B.ÌýHershfield Chair in Therapeutic Endoscopy (with SteveÌýHeitman occupying the Chair), to launch and expandÌýCReATE. He has since been successful at obtaining external funding for CReATE-related research, includingÌýmultiple project grants from the Canadian InstitutesÌýof Health Research and awards from the AmericanÌýCollege of Gastroenterology and American Society forÌýGastrointestinal Endoscopy (ASGE). Thus, via the initialÌýmodest commitment of internal funds, the program hasÌýraised over $3M in external support towards research.

Ucalgary’s research program is widely recognized for itsÌýmethodologically rigorous and impactful work in advancedÌýendoscopy, including the recent publication of a multi-centreÌýrandomized trial on ERCP-related outcomes in JAMAÌýInternal Medicine^[1]. Other important research works haveÌýbeen disseminated from the group on ERCP adverseÌýevents and patient-reported outcome measures, amongÌýothers.^[2],[3] Importantly, Nauzer Forbes also continues toÌýserve on the ASGE’s Standards of Practice CommitteeÌýsince 2020, meaning that UCalgary has a recognizedÌýimpact on broadly disseminated guidelines from theÌýworld’s largest endoscopy society.Ìý

Several other internationally recruiting prospective studiesÌýand trials in advanced endoscopy are underway atÌýUCalgary. The recent returns of Drs. Puja Kumar and PaulÌýBelletrutti from world-renowned sabbaticals in advancedÌýtissue resection and the recent recruitment of Dr. SuqingÌýLi, an advanced endoscopist with interests in translationalÌýmedicine, together herald a new era in Áù¾ÅÉ«Ìà clinicalÌýand research programs. Building off their existing researchÌýinfrastructure, the group is poised to continue toward theirÌýgoal of having UCalgary recognized as a world-classÌýclinical and academic centre for advanced endoscopy.

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^{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.}