Increasingly, the 4th year of advanced endoscopy is designed to gear one towards an academic career in therapeutic endoscopy. It has become much like the 4th year for transplant hepatology. With that in mind, I would look for the following in a general GI fellowship:
1. Presence of an in-house advanced endoscopy fellowship - this dilutes your practical ERCP experience during the 3 general years, but increases your chance for matching a 4th year spot
2. Well known therapeutic endoscopy faculty - LoR, research, etc. This will also allow you to build a niche within advanced endoscopy (ie. pancreatitis, small bowel malignancy, NOTES, therapeutic EUS, etc.). Academic "advanced endoscopy" is not just doing ERCP/EUS.
3. Built-in research time during the first 3 years
