GI Clinical Procedures & Protocols 3 — Questions and Answers
Question 1: The Paris classification in endoscopy is used to describe:
- The morphology and depth of superficial GI lesions (Correct answer)
- Severity of acute upper GI bleeding
- Location of colorectal adenomas
- Degree of bile duct dilation on ERCP
Correct answer: The morphology and depth of superficial GI lesions
The Paris classification categorizes superficial neoplastic lesions (polypoid, flat, and depressed subtypes) in the GI tract to predict submucosal invasion risk.
Question 2: A patient with known coagulopathy (INR 2.8) requires diagnostic colonoscopy with possible biopsy. The most appropriate pre-procedure management is:
- Proceed without correction as biopsy risk is minimal
- Administer vitamin K and repeat INR before proceeding (Correct answer)
- Bridge with low-molecular-weight heparin
- Transfuse FFP to achieve INR <1.5 before the procedure
Correct answer: Administer vitamin K and repeat INR before proceeding
For elective procedures with bleeding risk, correcting INR with vitamin K to <1.5–2.0 is preferred over FFP unless there is urgent clinical need.
Question 3: During flexible sigmoidoscopy, resistance is encountered at the rectosigmoid junction. The recommended technique is:
- Apply steady forward pressure to advance the scope
- Torque the scope and use abdominal pressure while withdrawing slightly (Correct answer)
- Insufflate additional air to straighten the colon
- Abort the procedure and schedule CT colonography
Correct answer: Torque the scope and use abdominal pressure while withdrawing slightly
Paradoxical withdrawal with torque (jiggling technique) and external abdominal pressure straightens the sigmoid loop and allows scope advancement.
Question 4: Which scoring system is used intraoperatively or endoscopically to assess the extent of ulcerative colitis?
- Mayo Score
- Harvey-Bradshaw Index
- CDAI
- Baron Score (Correct answer)
Correct answer: Baron Score
The Baron Score (0–3) assesses mucosal appearance at sigmoidoscopy/colonoscopy, grading from normal to spontaneous bleeding mucosa in ulcerative colitis.
Question 5: The 'pull' technique in PEG tube placement involves:
- Pushing the tube through the abdominal wall under fluoroscopy
- Pulling the tube from inside the stomach to the outside via a wire (Correct answer)
- Using a balloon dilator to enlarge the gastric stoma
- Pulling the stomach against the abdominal wall with T-fasteners
Correct answer: Pulling the tube from inside the stomach to the outside via a wire
In the pull technique, a guidewire is passed through the abdominal wall into the stomach and grasped endoscopically, then the PEG tube is attached and pulled back through the mouth and out the abdominal wall.
Question 6: Cap-assisted endoscopy is particularly useful for improving visualization of:
- The third portion of the duodenum
- The ileocecal valve and terminal ileum
- The right colon and behind haustral folds (Correct answer)
- The gastroesophageal junction from below
Correct answer: The right colon and behind haustral folds
Transparent cap-assisted colonoscopy improves adenoma detection in the right colon by flattening haustral folds and enabling views behind them.
Question 7: A water-jet assisted colonoscopy technique is primarily used to:
- Inject saline into the submucosa before polypectomy
- Clear the colon lumen of stool without air insufflation (Correct answer)
- Dilate strictures during the procedure
- Deliver hemostatic agents to bleeding sites
Correct answer: Clear the colon lumen of stool without air insufflation
Water-exchange colonoscopy replaces air insufflation with water infusion and suctioning, improving patient comfort and adenoma detection, especially in the right colon.
GI Clinical Procedures & Protocols 3
The Paris classification in endoscopy is used to describe: