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GI Boards November 20th 2024 > Endoscopy Best Practices > Flashcards

Endoscopy Best Practices Flashcards

1
Q

Do esophagel gastric inlet patches require biopsy?

A

NO

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2
Q

What is the RISK of REBLEEDING without EGD intervention of a FORREST Class IIa ULCER (non-bleeding visible vessel)?

A

50%

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3
Q

HIV patient with pill dysphagia was noted to have this lesion on EGD?

A

Candida with SQUAMOUS PAPILLOMATA

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4
Q

What is this finding and what is recommended?

A

TYPE I CHOLEDOCHOCELE - HIGH RISK for CHOLANGIOCARCINOMA - SURGERY

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5
Q

What is this caused by and how do you treat it?

A

HSV ulcer - multinucleated GIANT cells - PERIPHERAL biopsy and treat with ACYCLOVIR

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6
Q

Spindle Cells, CD117 positive stain?

A

GIST - muscularis propria

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7
Q

Patients >65 yo, MI within 30 days, Obesity, HTN, DM, CAD are all at an increased RISK of what?

A

CARDIOPULMONARY complications on EGD

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8
Q

Do patients with EOE have an increased risk for perforation when performing an EGD with BALLOON DILATION?

A

NO!

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9
Q

Should PEG patients get PROPHYLACTIC antibiotics?

A

YES!

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10
Q

ASPIRATION and BACTERIAL PERITONITIS are increased RISK factors when performing this EGD procedure?

A

Variceal Banding

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11
Q

Patient gets TOPICAL anesthetic spray and turns CYANOTIC with LOW SpO2, but behaves normally, what happened?

A

METHEMOGLOBIN from ANESTHETIC SPRAY (arterial PaO2 is normal) - altered form of HEME IRON from ferrous (Fe2+) to ferric (Fe3+) carrying less oxygen - MEASURE with CO-OXIMETER

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12
Q

How is METHEMOGLOBINEMIA treated as when a patient turns CYANOTIC when given TOPICAL ANESTHETIC SPRAY?

A

METHYLENE BLUE

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13
Q

Post SNARE CAUTERY POLYPECTOMY, pt presents with perforation-like symptoms of abdominal PAIN, FEVER, LEUKOCYTOSIS, but NO FREE AIR is seen on imaging, what happened?

A

TRANSMURAL BURN (POST POLYPECTOMY COAGULATION Syndrome)

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14
Q

When a patient has an ACUTE GIB and is on WARFARIN, and ONLY if needed, what is recommended for REVERSAL?

A

PCC (Prothrombin Complex Concentrate) - 4 factors
NOT FFP (because it takes a large volume), NOT Vit K (takes 24-48 hrs)

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15
Q

ACUTE GIB should get EGD in what time frame?

A

24 HOURS

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16
Q

When a patient has an ACUTE GIB and is on DIRECT-ACTING ORAL ANTICOAGULANTS, what is recommended for REVERSAL?

A

DO NOT give Prothrombin Complex Concentrate (PCC); DO NOT give the idarucizumab for dabigratan nor the adnexanet alfa for apixaban or rivaroxaban

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17
Q

When a patient has an ACUTE GIB and is on ANTIPLATELET AGENTS, what is recommended for REVERSAL?

A

DO NOT give PLATELT TRANSFUSION if PLATELETS are >100,000
DO NOT stop ASA for SECONDARY cardiac prevention
If ASA is stopped, RESUME right after hemostasis

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18
Q

For ELECTIVE PROCEDURES, what is recommended for patients on WARFARIN?

A

If NOT HIGH-RISK procedure, CONTINUE WARFARIN

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19
Q

For ELECTIVE PROCEDURES, if WARFARIN is stopped, is BRIDGING recommended?

A

NO! EXCEPT:
1. MECHANICAL VALVE
2. A-FIB with CHADSVASC2 >5
3. PRIOR CLOT when warfarin was stopped

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20
Q

For ELECTIVE PROCEDURES, what is recommended for patients on DIRECT-ACTING ORAL ANTICOAGULANTS?

A

TEMPORARY INTERRUPTION

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21
Q

For ELECTIVE PROCEDURES, what is recommended for patients on DUAL ANTIPLATELET THERAPY for SECONDARY CARDIOVASCULAR PREVENTION where one of the agents is ASA?

A

STOP the NON-ASA drug and KEEP the ASA

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22
Q

WHEN should WARFARIN, ANTIPLATELET AGENTS and DIRECT-ACTING ORAL ANTICOAGULANTS be RESTARTED after ELECTIVE procedures?

A

WARFARIN and ANTIPLATELET agents: SAME DAY
DIRECT-ACTING ANTICOAGULANTS: NEXT DAY

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23
Q

What should be DONE with ANTICOAGULANTS and ANTIPLATELET AGENTS when performing HIGH-RISK e**ndoscopic procedures (EUS/FNA, EMR, ESD, POEM, ERCP sphincterotomy, etc.)?

A

HOLD THEM

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24
Q

How LONG is WARFARIN HELD prior to a HIGH-RISK endoscopic procedure?

A

5 DAYS

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25
Q

Are ANTIBIOTICS needed to prevent ENDOCARDITIS for ANY endoscopic procedures?

A

NO!

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26
Q

For a patient with BILIARY OBSTRUCTION who is undergoing ERCP, when would they require ANTIBIOTIC prophylaxis?

A

ERCP with INCOMPLETE DRAINAGE (PSC, HILAR stricture) and those who have had a LIVER TRANSPLANT

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27
Q

For what EUS procedure is ANTIBIOTIC PROPHYLAXIS suggested?

A

EUS with CYST BIOPSY

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28
Q

For ALL patients with CIRRHOSIS and GI BLEED, what is REQUIRED?

A

ANTIBIOTIC PROPHYLAXIS

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29
Q

Do patients with VASCULAR GRAFTS, PROSTHETIC JOINTS or PERITONEAL DIALYSIS require antibiotic prophylaxis for endoscopic procedures?

A

NO! (only suggested for colonoscopy and peritoneal dialysis)

30
Q

What occurs with ingestion of DETERGENT PODS and BUTTON BATTERIES?

A

SEVERE MUCOSAL INJURY

31
Q

LIQUIFACTIVE NECROSIS of ESOPHAGUS is seen with ingestion of what?

A

ALKALI

32
Q

COAGULATION NECROSIS of STOMACH is seen with the ingestion of what?

A

ACID

33
Q

Why should ENDOSCOPY be performed within 24 HOURS of ingestion of CAUSTIC materials?

A

GRADE SEVERITY of injury and predict PROGNOSIS

34
Q

What is the MOST IMPORTANT TREATMENT in CAUSTIC INGESTION injury?

A

NPO and SUPPORTIVE (nothing else)

35
Q

When should ESOPHAGEAL CANCER be screend for in a patient that ingested CAUSTIC meterial?

A

AFTER 10-20 YEARS, every 2-3 YEARS

36
Q

What is the RECOMMENDED performance target for reaching the CECUM for ALL colonoscopies vs SCREENING colonoscopies?

A

ALL: ≥90%
SCREENING: ≥95%

37
Q

What is the MINIMUM TARGET ADR (Adenoma Detection Rate) for MEN & WOMEN in screening colonoscopies?

A

≥30% MEN
≥20% WOMEN
≥25% COMBINED

38
Q

When should the FIRST COLONOSCOPY be performed after SURGERY for COLON CANCER?

A

1 YEAR

39
Q

What is the HIGHEST ENDOSCOPE - to - PATIENT infection transmission risk?

A

ERCP (scopes with ELEVATORS)

40
Q

What should be done post colonoscopy if this is seen?

A

Early SURGICAL consult (perforation with air under diaphragm)

41
Q

What is the ROLE of EGD after CAUSTIC ingestion, which should be performed WITHOUT DELAY?

A

To GRADE the findings using a STANDARDIZED CLASSIFICATION system

42
Q

On colonoscopy, you see these in the CECUM, how do you treat?

A

Mebendazole or Albendazole (pinworm in cecum)

43
Q

Alcoholic with BLEED from these, what is the recommended NEXT step?

A

CT ABDOMEN (look for evidence of PANCREATITIS) - because this is caused by SPLENIC VEIN THROMBOSIS

44
Q

RECTAL VARICES such as these are caused by PORTAL HTN and can cause MASSIVE BLEED, are treated how?

A

𝞫-blockers, TIPS

45
Q

This finding in the TERMINAL ILEUM represents what?

A

NORMAL Lymphoid Hyperplasia

46
Q

What DEPTH of COLON INVASION is considered colon CANCER?

A

SUBMOCOSAL INVOLVEMENT

47
Q

Stage 0 COLON CANCER means what DEPTH of INVASION?

A

MUCOSA

48
Q

Stage I COLON CANCER means what DEPTH of INVASION?

A

SUBMUCOSA (Superficial Ia < 1000 microns; Deep Ib >1000 microns)

49
Q

Stage II COLON CANCER means what DEPTH of INVASION?

A

MUSCULARIS PROPRIA

50
Q

Stage III COLON CANCER means what DEPTH of INVASION?

A

LN INVOLVEMENT

51
Q

Stage IV COLON CANCER means what DEPTH of INVASION?

A

ADJACENT or DISTANT ORGANS

52
Q

Depth of invasion >1000 microns (1 mm) for SESSILE (flat) polyps, < 1-2 mm from resection margin, LN invasion, POOR DIFFERENTIATION, HIGH-GRADE BUDDING, PIECEMEAL RESECTION

A

UNFAVORABLE HISTOLOGIC criteria of a MALIGNANT POLYP (send patient for ADJUVANT SURGICAL RESECTION)

53
Q

How MANY unfavorable histologic criteria make a malignant polyp a HIGH-RISK for recurrence?

A

JUST ONE (depth >1000 microns, < 1 mm resection margin, LN invasion, poor differentiation, piecemeal)

54
Q

If a patient is NOT a good SURGICAL CANDIDATE and has a resected colon polyp with UNFAVORABLE HISTOLOGY, what is the recommendation?

A

Do NOT RECOMMEND SURGERY as most high-risk cases will have no residual cancer in the surgical specimen

55
Q

What is REQUIRED to be able to measure DEPTH of INVASION for a MALIGNANT POLYP?

A

EN-BLOCK RESECTION not piecemeal and retrieved directly not suctioned through the scope channel

56
Q

What do the terms CONVENTIONAL ADENOMA and TRADITIONAL SERRATED ADENOMA mean?

A

DYSPLASIA (low or high grade, tubular, tubulovillous, villous)

57
Q

Which is higher-risk, or ADVANCED lesion, TUBULAR or VILLOUS?

A

VILLOUS (any villous components)

58
Q

Which POLYP MORPHOLOGY have the HIGHEST RISK for DYSPLASIA and INVASION?

A

DEPRESSED

59
Q
A
60
Q

Of the LATERAL SPREADING COLON POLYPS (>1 cm LATERAL SPREAD), what SURFACE feature makes some a HIGHER RISK for CANCER and for SUBMUCOSAL FIBROSIS?

A

A SMOOTH, HARD surface, especially if BULKY or there is a DEPRESSION present (the GRANULAR lumpy bumpy surface polyps are LOWER RISK)

61
Q

Adenoma Detection Rates (ADR) are meant only for CONVENTIONAL ADENOMAS (not serrated) and in which colonoscopies?

A

FIRST-TIME SCREENING COLONOSCOPIES
ADR PREDICTS interval cancer (interval between colonoscopies)

62
Q

What is the MINIMUM Adenoma Detection Rate (COMBINED) and what should we be ASPIRING for?

A

Minimum: 25% (30% men, 20% women)
Aspiring for: 50%
FIT positive ADR: (45% men, 35% women for 40% combined)

63
Q

What is RECOMMENDED CECAL WITHDRAWAL time?

A

6 MIN (preferred 8-9)

64
Q

What** SCOPE LIGHT** is best for better Adenoma Detection Rate (ADR)?

A

NBI (chromoendoscopy) better than white light

65
Q

What is the CECAL INTUBATION RATE recommended for SCREENING colonoscopies? For OVERALL colonoscopies?

A

Screening: 95%
Overall: 90%

66
Q

Should pts with BENIGN polyps be sent to SURGERY?

A

NO! (have these reviewed by advanced endoscopist)

67
Q

ALL COLON lesions ≤10 mm should be resected HOW?

A

COLD SNARE polypectomy

68
Q

If in resecting a flat polyp, a piece of the polyp REISTS SNARING, what is the BEST way to REMOVE it?

A

AVULSION (hot or cold) - not APC or cautery

69
Q

On COLONOSCOPY you find ONE < 10 mm TUBULAR ADENOMA in a patient with no family histroy of coolon cancer, whats the NEXT colonoscopy screening INTERVAL?

A

7-10 YEARS

70
Q

On COLONOSCOPY you find ONE < 10 mm SESSILE SERRATED ADENOMA in a patient with no family histroy of coolon cancer, whats the NEXT colonoscopy screening INTERVAL?

A

5-10 YEARS

71
Q

On COLONOSCOPY you find ONE < 10 mm TUBULAR ADENOMA and ONE < 10 mm SESSILE SERRATED ADENOMA in a patient with no family histroy of coolon cancer, whats the NEXT colonoscopy screening INTERVAL?

A

5-10 YEARS (the more high-risk lesion dictates the interval - sessile serrated adenoma)

GI Boards November 20th 2024 (11 decks)

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