Endoscopy

Question 1

Has 13 hyperplastic polyps. High risk? Low risk? When to do next colonoscopy?

12 adenomas?

Answer 1

Low risk. 10 years

12 adenomas -> follow up surveillance in less than 3 years

Question 2

Pt comes in for colonoscopy. Get fentanyl, versed. Oropharynx is sprayed. Pt suddenly drops her O2 to 79%. Diagnosis? What to do

Answer 2

The lidocaine spray. Methemoglobinemia. Give methylene blue. It’s an electron donator. Donates electron to methemoglobin.

Blood gas shows methemoglibn lvl.

Question 3

What is the most common complication of peg tubes?

Answer 3

Infection at the peg tube site

Question 4

Timing of presentation after ERCP pancreatitis vs duodenal perforation

Answer 4

ERCP pancreatitis: 24-48 hrs

Duodenal perf: 5-7 days. <0.1%< 85% treated non-operatively

Question 5

Screening colonoscopy. 10 small adenomas completely removed. Follow-up?

Answer 5

Colonoscopy every 3 years

Question 6

Screening colonoscopy. 12 small adenomas completely removed. Follow up?

Answer 6

< 3 years

Question 7

Screening colonoscopy. 2 small tubular adenomas removed. Follow up?

Answer 7

5-10 years

Question 8

Screening colonoscopy. Removed 1 adenoma 1.2cm. follow up?

Answer 8

> 1cm: 3 year follow up

Question 9

Screening colonoscopy. Removed 1 villous adenoma. Follow up?

Answer 9

3 years. Villous adenoma: 3 years

Question 10

Screening colonoscopy. Sessile polyp removed in piecemeal. Follow up?

Answer 10

3-6 months

Question 11

Barrett with no dysplasia. Follow up?

Answer 11

3 years

Question 12

Cirrhotic with varices with:

• Mallory Weiss tear. What intervention first?
• bleeding varices. What intervention first?

Answer 12

• Mallory Weiss or other ulcers: epinephrine

- bleeding varices: band ligation

Question 13

1.7cm pedunculated polyp. Polypectomy shows adenocarcinoma up to but not involving the neck of the polyp. Margin (-)

• What haggit class?
• What to do next?
• chance of lymph node involvement?

Answer 13

• haggitt class I
• repeat cscope in 6 months. No surgery
• <1% chance of node invovlement

Class II invades the neck
III invades the stalk
IV: invades below the stalk

Question 14

Biopsy for Barrett’s. Four quadrant biopsies every

5mm?
1cm?
2cm?

Answer 14

Four quadrant biopsies every 1cm along the entire length of the abnormal mucosa

Question 15

What’s the pt body positioning for ercp?

Answer 15

Initially left lateral decubitus then prone when the scope is in the 2nd portion of the duodenum

Question 16

On ERCP what clock position are the ampulla, orifice of CBD and pancreatic duct located?

Answer 16

Ampulla: 12 o’clock
CBD: 11 o’clock
Pancreatic: 1 o’clock

Question 17

% chance high grade dysplasia harbors cancer in a biopsy specimen?

Low grade Barrett?

Answer 17

High grade: 45-50%

Low grade: ~10%

Question 18

for POEM, which layers of the esophagus are divided?

how is the outcome compared to heller myotomy?

Answer 18

inner circular muscle is divided. outer longitudinal layer is left intact

outcome is equivalent in terms of successful symptom resolution

Answer 19

true.

The current recommendation is that polyps 6 to 9 mm, although likely to be benign, be removed by colonoscopy or followed with a second CT colonography in 3 years. For lesions larger than 10 mm, sensitivity approaches 88%.

Question 20

first line management option for low grade dysplasia barretts?

Answer 20

radiofrequency ablation every 3 months for a maximum of 2 circumferential or 3 focal sessions.

if refuses ablation then survey Q6 months with 4 quad biopsies