Endoscopy Flashcards
Has 13 hyperplastic polyps. High risk? Low risk? When to do next colonoscopy?
12 adenomas?
Low risk. 10 years
12 adenomas -> follow up surveillance in less than 3 years
Pt comes in for colonoscopy. Get fentanyl, versed. Oropharynx is sprayed. Pt suddenly drops her O2 to 79%. Diagnosis? What to do
The lidocaine spray. Methemoglobinemia. Give methylene blue. It’s an electron donator. Donates electron to methemoglobin.
Blood gas shows methemoglibn lvl.
What is the most common complication of peg tubes?
Infection at the peg tube site
Timing of presentation after ERCP pancreatitis vs duodenal perforation
ERCP pancreatitis: 24-48 hrs
Duodenal perf: 5-7 days. <0.1%< 85% treated non-operatively
Screening colonoscopy. 10 small adenomas completely removed. Follow-up?
Colonoscopy every 3 years
Screening colonoscopy. 12 small adenomas completely removed. Follow up?
< 3 years
Screening colonoscopy. 2 small tubular adenomas removed. Follow up?
5-10 years
Screening colonoscopy. Removed 1 adenoma 1.2cm. follow up?
> 1cm: 3 year follow up
Screening colonoscopy. Removed 1 villous adenoma. Follow up?
3 years. Villous adenoma: 3 years
Screening colonoscopy. Sessile polyp removed in piecemeal. Follow up?
3-6 months
Barrett with no dysplasia. Follow up?
3 years
Cirrhotic with varices with:
- Mallory Weiss tear. What intervention first?
- bleeding varices. What intervention first?
- Mallory Weiss or other ulcers: epinephrine
- bleeding varices: band ligation
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?
- 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
Biopsy for Barrett’s. Four quadrant biopsies every
5mm?
1cm?
2cm?
Four quadrant biopsies every 1cm along the entire length of the abnormal mucosa
What’s the pt body positioning for ercp?
Initially left lateral decubitus then prone when the scope is in the 2nd portion of the duodenum
On ERCP what clock position are the ampulla, orifice of CBD and pancreatic duct located?
Ampulla: 12 o’clock
CBD: 11 o’clock
Pancreatic: 1 o’clock
% chance high grade dysplasia harbors cancer in a biopsy specimen?
Low grade Barrett?
High grade: 45-50%
Low grade: ~10%
for POEM, which layers of the esophagus are divided?
how is the outcome compared to heller myotomy?
inner circular muscle is divided. outer longitudinal layer is left intact
outcome is equivalent in terms of successful symptom resolution
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%.
first line management option for low grade dysplasia barretts?
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
